HYGIENE OF THE NURSERY 

STARR. 

EIGHTH EDITION 



GENERAL MANAGEMENT OF CHILDREN' 
FEEDING* DIET- LISTS- 
CLOTHING' SLEEP* 
EMERGENCIES- 
MASSAGE" 



ILLUSTRATED 




Class T?X tl__ 
Book .S 17 



Copyright N 



ms 



COPYRIGHT DEPOSIT 



HYGIENE OF THE NURSERY 



STARR 



BY THE SAME AUTHOR 



THE DIGESTIVE ORGANS IN CHILDHOOD. The 
Diseases of the Digestive Organs in Infancy and Childhood. 
With Chapters on the Investigation of Disease, the Manage- 
ment of Children, Massage, etc. Third Revised Edition. 
With Lithograph Plates and Wood Engravings. 

Price, Cloth, $3.00 net. 

P. BLAKISTON'S SON & CO., Publishers 

1012 Walnut Street, Philadelphia 



HYGIENE 

OF 

THE NURSERY 



INCLUDING THE GENERAL REGIMEN AND FEED- 
ING OF INFANTS AND CHILDREN; MASSAGE, 
AND THE DOMESTIC MANAGEMENT OF 
THE ORDINARY EMERGENCIES 
OF EARLY LIFE 



BY 
LOUIS STARR, M. D., L.L. D. 



EIGHTH EDITION 
WITH TWENTY-SIX ILLUSTRATIONS 



PHILADELPHIA 

P. BLAKISTON'S SON & CO. 

1012 WALNUT STREET 
1913 

Twenty- second Tlwusand. 






Copyright, 1913, by Louis Starr, M. D. 



THE. MAPLE. PRESS. TOHK. PA 



CI.A343168 



TO 
MY LITTLE PATIENTS 

SOME OF WHOM 

IN THE RAPID PASSING OF TIME, MAY SOON ASSUME 

PARENTAL DUTIES 

THIS VOLUME 

IS AFFECTIONATELY DEDICATED 



PREFACE TO THE EIGHTH EDITION, 



In the preparation of this edition of Hygiene 
of the Nursery the subject matter has been care- 
fully revised, and amended wherever necessary to 
keep abreast with the advances and improvements 
constantly being made in the methods of managing 
infants and children. Special attention has been 
given to the chapter on "Food," and numerous 
additions have been made to the "Dietary." 
These changes and additions the writer believes will 
materially enhance the working value of the book, 
and perhaps increase its claim to the favor which 
has been so flatteringly accorded to it in the past. 

LOUIS STARR. 
1818 South Rittenhouse Square, 
Philadelphia. 



PREFACE TO THE FIRST EDITION. 



Having a firm belief in the proverb that "an 
ounce of prevention is worth a pound of cure," the 
author has endeavored, in the succeeding pages, to 
point out a series of hygienic rules which, if applied 
to the nursling, can hardly fail to maintain good 
health, give vigor to the frame and so lessen suscep- 
tibility to disease. 

He feels, too, that intelligent parents are ever 
ready to be instructed and willing to cooperate in 
the great work of preventing disease — the highest 
aim of scientific medicine. 

While every woman of ordinary brain-power can 
do much to keep her baby well, she should recog- 
nize that years of training and experience are 
necessary to acquire the ability to put the full value 
upon symptoms, and to handle the tools of medicine. 
Therefore, little or no reference has been made to 
drugs or methods of medical treatment. 

The first chapter is written with the object of 
hinting to the mother when, by deviations from the 
features of health, she may expect the onset of dis- 
ease and call in professional counsel. The last is 
ix 



X PREFACE TO THE FIRST EDITION 

offered, not as a complete guide to the practice of 
physic, but simply for the sake of giving informa- 
tion upon questions that often arise in the nursery. 

The child's doctor, in our day, regulates his 
patient's diet, clothing, bathing and exercise, and 
looks into the hygiene of the nursery before he 
orders medicines, and if the mother has sound ideas 
upon these subjects she is no mean assistant. 

The author's thanks are due to Dr. W. M. 
Powell for efficient aid in the preparation of the 
manuscript and index, and to Dr. Allen J. Smith 
for the illustrations. 

LOUIS STARR. 
Philadelphia. 



CONTENTS. 



CHAPTER I. 

Page. 
The Features of Health i 

CHAPTER II. 
The Nursery 51 

CHAPTER III. 
The Xurse-maid 69 

CHAPTER IV. 

Clothing 75 

CHAPTER V. 
Exercise and Amusements 98 

CHAPTER VI. 
Sleep 11 1 

CHAPTER VII. 
Bathing 115 

CHAPTER VIII. 
Food 146 

CHAPTER IX. 
Dietary . : 230 

CHAPTER X. 
Massage 267 

CHAPTER XI. 
Emergencies 278 

Index 323 

xi 



HYGIENE OF THE NURSERY, 



CHAPTER I. 

THE FEATURES OF HEALTH. 

Every ill child presents certain well-defined alter- 
ations in the manner of performance of the various 
functions of the body. Thus, the pulse and respi- 
ration may be altered in character and frequency; 
the surface temperature may be elevated; the color 
and condition of the skin may be changed; the 
appetite may be diminished; weight may be lost, 
and so on. These alterations from the normal state 
are termed symptoms. 

Healthy children, on the other hand, as uniformly 
show evidences of their well-being, which, for want 
of a better name, may be called the features of 
health. Of these every mother should have a full 
knowledge, so that by appreciating variations she 
may anticipate the complete development of disease, 
and early summon skilled aid, at the time when it 
is of most servii e. 

Early life must be divided into two periods, 
namely, infancy and childhood. Infancy is the 
i 



2 HYGIENE OF THE NURSERY 

time elapsing between birth and the complete 
eruption of the milk teeth, an event that transpires 
about the end of the second year of life. Child- 
hood extends from this age to the development of 
puberty, or to the age of thirteen or fifteen years. 
It is important to remember these two divisions, as 
frequent reference will be made to them in the 
subsequent pages. 

With this brief preparation, the study of the 
features of health may be entered upon. 

i. The Face. — The face of a healthy, sleeping 
child wears an expression of absolute repose. The 
eyelids are completely closed, the lips very slightly 
parted, and, though a faint sound of rhythmical 
breathing may be heard, there is no visible move- 
ment of the nostrils. When awake and undisturbed, 
the healthy infant's face has a look of wondering 
observation. As age advances, intelligence gradu- 
ally supplants the wondering gaze, and all are 
familiar with the bright, round, happy face of per- 
fect childhood, so indicative of careless content- 
ment, and so mobile in response to emotions. 

Examples of Variations in Disease. — Incomplete 
closure of the eyelids, rendering the whites of the 
eyes visible during sleep, is a symptom in all acute 
and chronic diseases of a severe type; it is also to 
be observed when rest is rendered unsound by 
pain, wherever seated. Twitching of the eyelids, 



THE FEATURES OF HEALTH 3 

associated with oscillation of the eyeballs or 
squinting, heralds the visit of convulsions. Widen- 
ing of the orifices of the nose, with movements of the 
nostrils to and fro, points to embarrassed breathing 
from diseases of the lungs or their pleural invest- 
ment. Contraction of the brows indicates pain in 
the head; sharpness of the nostrils, pain in the 
chest; and a drawn upper lip, pain in the abdomen. 
To make a general rule, it may be stated that the 
upper third of the face is altered in expression in 
affections of the brain; the middle third in diseases 
of the chest, and the lower third in diseases of the 
organs contained in the abdominal cavity. 

2. The Skin and General Appearance. — In the 
new-born infant the color of the skin varies from 
a deep to a light shade of red. After the first week 
this redness fades away, leaving the surface yellow- 
ish-white. At times this yellow color is so marked 
that it might be mistaken for jaundice were it not 
that the whites of the eyes remain perfectly pearly, 
which is never the case in the disease mentioned. 
After the second week all discoloration disappears 
and the skin assumes its typical appearance. 

With certain well-known natural variations in 
complexion the skin of a healthy child is beauti- 
fully white and transparent. The cheeks, palms of 
the hands and soles of the feet have a delicate pink 
color, while the general surface is rosy in a warm 



4 HYGIENE OF THE NURSERY 

atmosphere and marbled with faint blue spots or 
lines in a cold one; this mottling is most marked 
on the extremities. As age advances the coloring 
becomes more pronounced, and until the comple- 
tion of childhood the complexion is much fresher 
than in adult life. 

Other characters of the healthy skin are a 
velvety smoothness and softness, a scarcely per- 
ceptible moisture, and a great degree of 
elasticity. 

If an infant be stripped the large size of the head 
and trunk, and the relatively short arms and even 
shorter legs, will strike the observer at once. This 
disproportion, especially noticeable in the head, is 
an actual one. For if in a child of one year, for 
example, the distance from the lower edge of the 
chin to the top of the head be measured, it will be 
found to be equal to one-fourth of the entire length 
of the body. The vertical length of the head, too, 
falls but little short of that of the trunk, and the 
latter in turn is nearly as long as the legs. 

Again, the abdomen is full and prominent, making 
the chest look, in comparison, rather contracted and 
narrow, and the navel is less deeply sunken than in 
adults. 

These features, which will be referred to more 
minutely in a later section, are most marked in 
young infants, and undergo gradual alterations as 



THE FEATURES OF HEALTH 5 

growth progresses and the child develops into the 
lithe, active youth or maiden. 

The shape of the head varies greatly between 
the round, bullet form and the elongated oval one. 
When it has been subjected to much pressure, 
instrumental or otherwise, during delivery, it is 
often so distorted as to shock the expectant mother. 
Little fear of permanent disfigurement need be 
entertained, however, as in time the deformed head 
usually assumes a natural shape. The same is true 
of less noticeable depressions, prominences and 
irregularities. But it should be remembered that 
restoration to symmetry must be left entirely to 
nature, as any attempt to press or mould the bones 
of the skull into shape rarely fails to injure the deli- 
cate brain beneath. 

The anterior fontanelle, or, as it is called by 
nurses, "the opening of the head," is readily seen 
and felt in infants under a year old. In the nor- 
mal state it is level with, or very slightly depressed 
below, the surrounding bones of the skull, and 
may be observed to pulsate, or rise and fall, 
rhythmically. It is soft to the touch and yields 
readily to pressure. 

Examples of Variations in Disease. — Lividity of 
the eyelids and lips is a sign of imperfect oxida- 
tion of the blood, and points to disease of the 
heart or lungs. A decided yellow color of the 



6 HYGIENE OF THE NURSERY 

skin and whites of the eyes is seen in jaundice; an 
earthy tinge of the face, in long-standing disease of 
the bowels; a waxy pallor in kidney disease, and 
paleness in any acute or chronic affection attended 
by exhaustion. 

Marked squareness of the head with projection 
of the forehead, a widely-open fontanelle, and a 




Fig. i. — Diagram Showing Shape op Heads. 
a. Normal head; b, Hydrocephalic head; c, Rickety head. 



relatively small face indicate rickets. A very large, 
globular head is characteristic of hydrocephalus or 
"water on the brain;" bulging of the fontanelle is 
also a symptom of this disease. In this connection 
it must be observed, however, that certain children, 
in every respect healthy, are born with relatively 



THE FEATURES OF HEALTH 7 

large globe-shaped heads. This peculiarity is 
especially apt to be observed when one of the 
parents — notably the father — has the same charac- 
teristic. In order to indicate disease, the deformity 
must be marked and combined with a widely open, 
bulging fontanelle, or with indications of impaired 
brain activity. Depression of the fontanelle shows 
general debility and the need of food or stimulants. 

The accompanying diagram (Fig. 1) will aid in 
explaining this subject. 

Great distention of the abdomen is usually due 
to an accumulation of gas in the intestines, and 
indicates disease of this portion of the digestive 
tract; marked depression, on the other hand, is 
encountered in serious brain affections, in cholera 
infantum, inflammation of the intestines and dys- 
entery. 

3. Development.— To be robust the newly born 
infant must have a certain average length and 
weight. The length varies between sixteen and 
twenty-two inches, and the weight between six and 
eight pounds. 

From the first day, growth or increase in length 
and weight steadily progresses according to certain 
definitely fixed rules. 

Length increases most rapidly during the first 
week of life; afterward the progress is almost uni- 
form up to the fifth month, and then it becomes less 



8 



HYGIENE OF THE NURSERY 



rapid, though still uniform, until the end of the 
twelfth month. 

These facts may be seen in the following table: 



Age. 


Length. 


Birth 


19.5 inches. 


i month 


20.5 inches. 


2 months 


21. inches. 


3 months 


22 . inches. 


4 months 


23 . inches. 


5 months 


23 . 5 inches. 


6 months 


24 . inches. 


7 months 


24.5 inches. 


8 months 


25. inches. 


9 months 


25.5 inches. 


io months 


26 . inches. 


ii months 


26.5 inches. 


12 months 


27. inches. 



During the second year the increase is from three 
to five inches; in the third from two to three and 
a half inches; in the fourth from two to three inches, 
and from this age up to the sixteenth year the 
average annual gain is from one and two-thirds to 
two inches. 

In the first three days of life there is always a 
loss of weight, but by the seventh day the baby 
should have regained weight and be as heavy as 



THE FEATURES OF HEALTH 

at birth. The period of most rapid gain in this 
respect is during the first five months of life. The 
maximum is attained during the second month, 
when the increase is from four to seven ounces each 
week. Throughout the next three months the 
increase amounts to about five ounces per week, 
and in the remaining months of the first year, from 
two to five ounces. 

The subjoined table shows the average rate of 
gain: 



Age. 


Weight. 


Birth 


7 pounds. 


1 month 


7f pounds. 


2 months 


<p£ pounds. 


3 months 


1 1 pounds. 


4 months 


12^ pounds. 


5 months 


14 pounds. 


6 months 


15 pounds. 


7 months 


16 pounds. 


8 months 


17 pounds. 


9 months 


18 pounds. 


10 months 


19 pounds. 


11 months 


20 pounds. 


12 months 


21 pounds. 



Increase in weight and stature are so closely re- 
lated to the quality and quantity of food supplied to 



HYGIENE OF THE NURSERY 



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THE FEATURES OF HEALTH 





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12 HYGIENE OF THE NURSERY 

the infant, and to the processes of digestion, 
absorption and assimilation, in other words, are 
such perfect indices of proper nutrition or the re- 
verse, that it is important to keep a record, during 
the first year at least, of these two features of de- 
velopment. This can be graphically accomplished, 
and so more readily appreciated, by placing the 
data upon a chart, such as shown by Fig. 2. Here 
the average normal weight-gain and increase in 
length are indicated respectively by the blue and 
red lines. The figures at the top of the main chart 
denote the age by weeks, the heavy vertical lines 
mark periods of four weeks, the lighter, periods 
of one week. The figures on the left are numerals 
of weight, the heavy horizontal lines mark pounds, 
the lighter, quarter-pounds. The intersection of 
these sets of lines form squares, one for every weight 
and age. In making the record mark a dot in the 
square corresponding to the weight and age. At 
the next observation . make a second dot in the 
proper square, and so on. These dots are con- 
nected by a line, and a comparison of this line with 
the test blue line shows at once whether or not the 
special infant's weight-gain is normal. Gain in 
length is marked in the same way, near the red 
line, in the upper division of the chart; the figures, 
already mentioned as indicating the age in weeks, 
applying equally to this part of the record, while 



THE FEATURES OF HEALTH 1 3 

the numbers at the extreme top of the chart indicate 
length in inches. 

From the first to the tenth year there should 
be a yearly gain of at least four or five pounds. 
After, to the sixteenth year, of about eight pounds 
in the same period. 

Parents frequently overestimate the weight of 
their children by placing them upon the scales 
when completely dressed. To be accurate, the 
weight of the clothing must be subtracted. This 
may be estimated at about three pounds for a child 
of three to five years, four pounds for one of eight 
years, and eight pounds at fifteen years. 

Another reliable evidence of the proper progress 
of development is the increase in the girth of the 
chest. In an infant weighing seven pounds and 
measuring nineteen and a half inches at birth, the 
girth should be a little over thirteen inches. By 
the fourth month it should be fifteen inches; by 
the sixth, sixteen; by the twelfth, about seven- 
teen; by the fifth year, twenty-one, and by the 
sixteenth year, thirty inches. 

As already mentioned, the proportions of the 
different members of the frame in infancy differ 
materially from those of adolescence. 

Primarily the head and secondarily the body are 
large when compared with the arms and legs, but 
in the progress of healthy development this (lis- 



H 



HYGIENE OF THE NURSERY 



proportion is gradually lessened until the perfect 
human figure is attained. This developmental 
process, however, does not affect all parts of the 
body equally, as may be seen in the accompanying 
diagram.* (Fig. 3.) 

The description is so well put in the journal from 
which this figure is taken that I cannot do better 
than quote it word for word: 




Fig. 3. — Diagram Showing Relative Stature from i to 22 
Years of Age. 

"The six figures represent the average relative 
stature of males of the ages of one, five, nine, thir- 
teen, seventeen, and twenty-two years. It will be 
noticed that the figures all stand on a level plain. 
The tops of the heads are connected by a dotted 
line, and the height of each figure is divided into 

♦"Babyhood," Vol. II. page3n. Paper by Leroy M. Yale, M. D. 



THE FEATURES OF HEALTH 1 5 

four equal parts, the points of division being con- 
nected with the corresponding ones in each figure. 
If the rate of growth were uniform the dotted lines 
connecting the heads would, of course, be straight 
if a child for every year were included in the rank. 
But in the earlier years the growth is much more 
rapid than it is later, and hence the line is a curve, 
rising quite suddenly at the first, and becoming 
natter toward the end of growth. It is to be under- 
stood that these are all averages, including, but not 
showing, the extremes of slowness and rapidity 
of growth as well as fitfulness of growth. The 
diagram also shows the different development of 
different parts of the person. The head, for in- 
stance, in the child of one year is nearly one-fourth 
of the whole height; that of the adult is about 
two-thirteenths, or, to use the phrase of artists, 
the little child is not much more than four heads 
high, while the adult of twenty-two is about six 
and one-half heads high; and even this is a much 
larger head than the average adult has. Notice 
that the third dotted line, marking one-half of the 
total height, crosses the navel in the infant, while 
in the adult the half height mark is but little above 
the juncture of the legs and the body, which shows 
how much larger, proportionately, the body of an 
infant is than an adult's. If this same line be fol- 
lowed it will be noticed that it keeps well up in 



1 6 HYGIENE OF THE NURSERY 

the abdopien until after the age of nine. Between 
that age and puberty the growth of the lower ex- 
tremities is usually very rapid, and the well-known 
'shooting up' of boys and girls takes place, the 
whole person growing, but the lower part in par- 
ticular. Similar changes of location will be noticed 
by following the quarter-lines, but the changes are 
not so abrupt." 

It may be well to mention here that children 
will often remain, for a considerable time, almost 
stationary in height, and then have periods of very 
rapid growth. The latter is often to be observed 
in the ninth or tenth year, and again at the approach 
of puberty. Variations in weight-gain are also 
often to be observed; these seem to hold a defi- 
nite relation to the fluctuations in the rapidity of 
height-increase. 

Besides these points, which are the most reliable 
evidences of the proper progress of development, 
there are certain features that appeal more directly 
to the notice of parents, and on this account deserve 
consideration. The age at which a child sits erect, 
at which it creeps, walks or talks, are instances of 
the class of features referred to. 

The head can usually be held erect by the end 
of the third month and the body maintained in the 
sitting posture a month later. By the sixth month 
the infant can sit up with ease, accomplish many 



THE FEATURES OF HEALTH 1 7 

movements with the arms, hands and fingers, and 
enjoy playthings. At the eighth month he may 
be able to creep; by the ninth or tenth, to drag 
himself upon his feet with the assistance of his 
hands and arms and some artificial support; by the 
eleventh, to walk with assistance; by the fourteenth, 
to walk alone, and by the eighteenth, to run. 

At eight months an infant will imitate sounds 
and articulate several syllables; at ten, can often 
speak one or two words, and after twelve months 
is able to join several words together. 

The anterior fontanelle should be completely 
closed at some period between the fifteenth and 
twentieth months. 

Tears begin to be secreted during the third or 
fourth month, and saliva, between the fifth and 
sixth. 

After birth both hair and eyes often change color 
as age advances. When an alteration takes place 
in the eyes — which are quite commonly blue or 
blue-gray in the new-born — it begins about the 
sixth or eighth week and may be to cither a lighter 
or darker hue. Changes in the hair begin later, the 
tendency always being to darken, and the most 
marked alteration occurring between the seventh 
and fourteenth years. 

Examples of Variations in Disease. — If on being 
measured and weighed, a child be found to fall 



l8 HYGIENE OF THE NURSERY 

short of the normal standard for its age, and if, 
at the same time, there be a want of plumpness of 
body, roundness of limb, and firmness of flesh, the 
existence of some fault in diet or in the digestion 
and absorption of food must be inferred. 

A delay in walking may be due to general feeble- 
ness or to paralysis of the muscles of one or both 
legs, and a limping gait with pain in the knee 
suggests hip-joint disease. 

Closure of the fontanelle is retarded by the 
disease called rickets, and also by hydrocephalus 
and constitutional syphilis. 

It is well to be cognizant of the fact that girls 
develop more rapidly than boys, and that the second 
or later children of the same family, by imitating 
their elders in the nursery, learn to talk and walk 
earlier than those who are born first. 

4. Position and Gestures. — The complete re- 
pose depicted on the countenance of a sleeping 
child when free from illness is shown also by the 
posture of the body. The head lies easy on the 
pillow, the trunk rests on the side, slightly inclined 
backward, the limbs assume various but always 
most graceful attitudes, and no movement is 
observable but the gentle rise and fall of the 
abdomen in respiration. In the waking state, the 
child, after early infancy, is rarely still. The move- 
ments of the arms, at first awkward, soon become 



THE FEATURES OF HEALTH 10. 

full of purpose as he reaches to handle and examine 
various objects about him. The legs are idle 
longer, although these, too, soon begin to move 
about with method, feeling the ground in prepara- 
tion, as it were, for creeping and walking. 

Examples of Variations in Disease. — Restless 
sleep, with a desire to be rocked, fondled or "walked" 
in the nurse's arms, are common symptoms of acute 
attacks of illness, especially when attended by pain. 
Children beyond the age of infancy toss about 
uneasily in bed or want a change from the bed 
to the lap, under similar circumstances. Extreme 
and long-continued drowsiness and quietness, on 
the other hand, often precede the onset of such 
specific fevers as scarlatina or measles. 

Sleeping with the head thrown back and the 
mouth open indicates enlarged tonsils or adenoid 
growths; a tendency to "sleep high," or with the 
head and shoulders elevated by the pillow, accom- 
panies disease of the heart and lungs, and "sleeping 
cool," that is, resting only after the bedclothes have 
been kicked off, is an early symptom of rickets. 

Frequent carrying of the hand to the head, ear, 
or mouth shows headache, earache, or pain of 
a coming tooth. Constant rubbing of the nose is 
a feature of irritation of the bowels or stomach. 

Should the thumbs be drawn into the palms of 
the hands, and the fingers tightly clasped over 



20 HYGIENE OF THE NURSERY 

them, or if the toes be strongly flexed or extended, 
a convulsion may be expected. 

5. The Voice. — Crying is the chief if not the 
only method that the young infant possesses of 
making known his displeasure, discomfort or suffer- 
ing and affords almost the sole means of determin- 
ing the characters of the voice at this early age. 
Again, even long after the powers of speech have 
been developed, the cry continues to be the main 
channel of complaint. 

One rarely hears a healthy child cry, unless a 
harsh word, a fall or a blow cause a passing storm 
of grief, anger or pain. Hence, frequent, peevish 
crying points to some disturbance of the healthy 
balance. 

The sound of the voice, whether in crying or 
speaking, should have a clear ring, without either 
muffling, hoarseness or nasal tone. Weeping 
should accompany crying, after the establishment 
of tear secretion. Cough, although not a normal 
vocal sound, is also worthy of attention. 

Examples of Variations in Disease. — Incessant, 
unappeasable crying is usually due to earache or 
hunger; it frequently, too, is caused by the constant 
pricking of a badly-adjusted safety-pin or other 
mechanical irritant. 

If crying occur during an attack of coughing it 
is an indication of some painful affection of the 



THE FEATURES OF HEALTH 21 

chest; if just before or after an evacuation of the 
bowels, of intestinal pain. 

When the cry has a nasal tone it should suggest 
swelling of the lining membrane of the nose, or 
other obstructing condition. Thickening and indis- 
tinctness occur with throat affections. A loud, 
brazen cry is a precursor of spasmodic croup, and 
a faint, whispering cry, of true or membranous 
croup. Hoarseness points to disease of the lining 
membrane of the larynx, either catarrhal or syphi- 
litic in nature. 

Finally, a manifest unwillingness to cry can be 
seen in pneumonia and pleurisy, when the dis- 
ease is severe enough to interfere materially with 
breathing. 

Tear-secretion having been established, it is a 
bad omen if the secretion be arrested during the 
progress of an illness, but an equally good one if 
there be no suppression, or if there be a reestab- 
lishment after suppression. 

The cough, like the voice, may be brazen in 
spasmodic croup, hoarse in laryngeal catarrh, and 
suppressed in true croup. The qualities "tight- 
ness" and "looseness" arc readily appreciated and 
give a good idea of the progress of lung affections, 
especially bronchitis, the former being an evidence 
of the beginning, the latter of the favorable termina- 
tion of an attack. 



2 2 HYGIENE OF THE NURSERY 

Cough is always unproductive, that is, unattended 
by expectoration, in children under seven years of 
age. 

6. Mode of Drinking and Swallowing. — By 
watching an infant taking the breast or bottle, 
some information can be obtained of the condition 
of the mouth and throat, and of the respiratory 
organs. A healthy child drinks continuously with- 
out stopping to breathe, and swallows easily. 

Examples of Variations in Disease. — If there be 
any soreness of the mouth the nipple will be held 
only for a moment and then dropped with a cry of 
pain. When the throat is affected in infants, swal- 
lowing is performed with a gulp, an expression 
of pain passes over the face, and no more efforts 
are made than required to satisfy the cravings 
of hunger. Older children, under similar circum- 
stances, drink little and refuse solid food. 

An infant suffering from the oppressed breathing 
of pneumonia or severe bronchitis, seizes the nipple 
with avidity, swallows quickly several times and 
then pauses for breath. In older children the act 
of drinking, which should be continuous, is inter- 
rupted in the same way. 

If the finger be put into the mouth of a healthy 
baby it will be vigorously sucked for some little 
time. Diminution of this act of suction during a 
severe illness is a sign of danger; its reestablish- 



THE FEATURES OF HEALTH 23 

ment a good omen. In conditions of stupor it is 
noticeably absent. 

7. Appetite. — Hunger and appetite must not be 
regarded as synonymous terms. The former is the 
craving of all the tissues of the body for nutritive 
material, or food, and is expressed by a sinking or 
craving sensation in the stomach. The latter, on 
the other hand, though it is certainly an attendant 
of hunger, is simply a sensation of the desire for 
something with a food-taste, having its seat in the 
mouth and surrounding parts. Appetite having its 
post, as it were, at the entrance of the stomach, 
may be regarded as a gate-keeper to supervise 
everything presented for entrance and to reject all 
that may be injurious either to the stomach or the 
general economy. 

Like its analogue the gate-keper, the trust- 
worthiness of the appetite may be destroyed by 
overindulgence and bad habits. Under the last 
head come the constant administration of too much 
or too little food, the use of overrich food and 
irregularity in meal hours. 

A healthy appetite — that is, one that leads a child 
to consume with enjoyment the food set before 
him — may be encouraged by muscular and mental 
exercise; by contentment; by regular habits as to 
the hours of eating; by the use of plain food only, 
and by varying the food, in a greater or less degree, 



24 HYGIENE OF THE NURSERY 

according to the age. If the quantity of food con- 
sumed at the regular meals does not come up to 
the parent's standard of sufficiency, it does nothing 
but harm to resort to too dainty feeding and to an 
encouragement to eat between meals. 

There can be no question that a good appetite is 
a useful as well as a pleasant faculty for a child to 
possess, for there is no doubt that food eaten with 
relish is much better digested and therefore more 
serviceable in nutrition than that which is simply 
crowded into the stomach. 

Examples of Variations in Disease. — Loss of appe- 
tite is encountered in febrile attacks and in acute 
disorders of the stomach. Inordinate appetite, on 
the contrary, is usually met with when too strong 
food has been administered. Here the increased 
hunger is due to the fact that the food administered, 
while it may be very rich in nutritive properties, is 
ill-adapted to the delicate digestive power of early 
life, and thus, by not being properly prepared for 
absorption, places the child in the anomalous 
position of starving in the midst of plenty. In more 
advanced children gluttony may depend upon gas- 
tric irritation, a condition which often leads older 
and presumably wiser heads to over-indulgence at 
table. 

8. Eructation. — Eructation or regurgitation is 
readily produced and of frequent occurrence in 



THE FEATURES OF HEALTH 25 

infancy, on account of the vertical position and 
more cylindrical outline of the stomach at this 
period of life. 

Babies suckled at a freely-secreting breast often 
eructate, though they may be in the best possible 
health. In these cases, the supply of food being 
large, the infant, as it lies at the breast, is apt to 
draw more than it needs and more than it can 
digest, and the stomach, through a wise provision 
of nature, rids itself of the superabundance by the 
simple act of regurgitation. In this process, which 
in reality is an evidence of health, there is no vio- 
lent muscular effort, as in retching or vomiting, nor 
any evidence of nausea, and the material ejected is 
the breast milk alone, either entirely unaltered or 
slightly curdled. 

In older children, expulsion of the contents of 
the stomach, or vomiting, may also occur after the 
stomach has been overladen. If the act be followed 
by relief from a feeling of general distress, head- 
ache and pain in the upper abdomen, it is not to be 
regarded as a symptom of disease. 

Examples of Variations in Disease. — Vomiting, 
with its violent muscular effort and the attendance 
of the train of symptoms embraced under the term 
nausea — namely, paleness, languor, faintness and 
an increased secretion of saliva — occurs in many 
different conditions. It may indicate disease of the 



26 HYGIENE OF THE NURSERY 

stomach, of the intestines, of the lungs or their 
pleural investment, and of the brain; or it may be 
an initial symptom of one of the eruptive fevers, 
scarlet fever or measles, for example, which con- 
dition, when existent, can only be determined by 
closely observing the special case. 

The character of the material ejected from the 
stomach is more definite. Thus, the expulsion of 
mucus is a symptom of gastric catarrh. The 
regurgitation of mouthfuls of curdled milk, partly 
digested food and liquid, so sour that it causes a 
grimace to pass over the face, is an indication of 
dyspepsia with fermentation and the formation of 
an irritant acid. The appearance of lumbricoid 
worms in the vomit, a not very infrequent occur- 
rence, shows, without dispute, the existence of these 
parasites in the digestive canal. 

9. The Faecal Evacuations. — The daily num- 
ber of evacuations of the bowels natural for a child 
varies greatly with its age. For the first six weeks 
there should be three or four movements every 
twenty-four hours. After this time, up to the end 
of the second year, two movements a day is the 
normal average. Subsequently, the frequency is 
the same as in adults — once per diem — though two 
or three movements in the same interval may occur, 
especially after overfeeding or after eating food 
difficult of digestion, and must be looked upon as 



THE FEATURES OF HEALTH 27 

conservative rather than as the evidence of ill 
health. 

During the first period the passages have the 
consistence of thick soup, are yellowish-white or 
orange-yellow in color, with sometimes a tinge of 
green; have a faint faecal, slightly sour odor, and 
are acid in reaction. In the second, they are 
mushy or imperfectly formed, of uniform consistence 
throughout, brownish-yellow in color, and have a 
more faecal odor. The last two characters become 
more marked as additions are made to the diet. 
After the completion of the first dentition the 
motions have the same appearance as in adult life; 
they are formed, are brownish in color, and have a 
decidedly faecal odor. 

Examples of Variations in Disease. — Many altera- 
tions occur in disease. The frequency of the 
movements may be increased, constituting diar- 
rhoea, or lessened, constituting constipation. In 
the former condition the consistency is diminished, 
in the latter, increased. Instead of being uniform 
throughout, the movement may be mixed, partly 
liquid, partly solid, indicating imperfect digestion, 
and curds of milk or pieces of undigested solid food 
may be mingled with the mass. Flaky, yellowish 
or yellowish-green evacuations containing whitish, 
( beesy lumps, are also met with in cases of indiges- 
tion. Scanty, lumpy evacuations, dark brown or 



28 HYGIENE OF THE NURSERY 

even black in color, and mixed with mucus, are 
characteristic of intestinal catarrh. Doughy, gray- 
ish, or clay-colored motions show an inactive liver. 
An intermixture of blood, altered blood clots, and 
shreds of mucous membrane, indicate ulceration of 
the intestinal lining, such as occurs in intestinal 
inflammation, typhoid fever, dysentery and tuber- 
culous disease. Watery, almost odorless passages 
occur in the later stages of summer complaint; 
most offensive, carrion-like motions, in both ca- 
tarrhal and tuberculous ulceration of the intestines, 
and sour-smelling evacuations in the diarrhoea of 
sucklings. The discovery of worms in the move- 
ments is the only certain evidence of the existence 
of intestinal parasites. 

This mere outline of the changes that may take 
place will serve to show how much may be learned 
from the evacuations, and the importance of pre- 
serving them for the physician's inspection. 

10. The Urine.— It is impossible to make a 
definite statement as to the number of times the 
urine is voided by a healthy infant in each twenty- 
four hours. In any given case the frequency will 
differ very much from day to day, depending upon 
the temperature of the surrounding air and the 
amount of moisture that it contains. Sometimes 
it will be necessary to change the napkin every 
hour during the day and three or four times at 



THE FEATURES OF HEALTH 20. 

night. Again, it may remain dry for six, eight, or 
even ten hours. Neither condition indicates dis- 
ease. If, however, the urine is not passed for twelve 
hours, a careful examination should be made. 

Between these two extremes there is a wide range 
of variation. 

As the child grows older the frequency dimin- 
ishes, and at the age of three years the number of 
voidings will be reduced to six or eight during the 
waking hours, and perhaps one at night. When 
the desire does arise during sleep, the child, if in a 
normal state, wakes up and demands the chamber, 
and never passes urine unconsciously. Wetting 
the bed, therefore, or the involuntary passage of 
the urine during sleep, is indicative of an abnormal 
condition and requires investigation. The quantity 
of urine voided at different ages may be stated as 
follows, the figures being approximate only: 

From birth to 2d year 8-12 fluid ounces. 

From 2d to 5th year I 5 _2 5 fluid ounces. 

From 5 th to 10th year 2 5~35 fluid ounces. 

From 10th to 15th year 3S _ 4° fluid ounces. 

From a few observations, I am led to believe that 
the quantity of urine voided by healthy children 
from the fourth to the seventh years is often not as 
large as supposed, eighteen to twenty ounces being 
the average in several cases in which I have made 
measurements. 



30 HYGIENE OF THE NURSERY 

The urine of an infant, while it wets, should not 
stain the napkin. 

Examples of Variations in Disease. — In certain 
cases of bad digestion the urine becomes very con- 
centrated and high-colored, and gives a light yellow 
tinge to the napkin. When the stain is decidedly 
yellow, jaundice is indicated, and other symptoms 
of this condition should be looked for. 

In older children a high-colored urine, and one 
which deposits a whitish or pinkish sediment on 
standing, is symptomatic of acute digestive dis- 
order, either catarrhal in its nature, or secondary 
to some acute febrile affection. A smoky, blackish 
hue, looking as if there had been an admixture of 
soot, is characteristic of the acute kidney disease 
that often follows in the wake of scarlet fever. In 
this state, too, there is a great diminution in the 
amount passed. The deposition of a "brick-dust" 
sediment in the napkin, or upon the bottom of the 
chamber after the urine has been standing for a 
time, indicates an excessive formation of uric 
acid. 

Painful urination points to inflammation of the 
bladder or urethra, a narrow orifice, a highly acid 
condition of the excretion, or stone in the bladder. 

ii. The Respiration. — In adults there are two 
well-marked types of respiration, viz., the abdominal 
and the superior costal. The abdominal — met with 



THE FEATURES OF HEALTH 3 1 

in perfection in adult males — is the type in which 
the movements of inspiration and expiration are 
performed by the muscles of the abdomen and 
lower third of the chest. In superior costal respi- 
ration, on the other hand, the movements are most 
marked in the upper third of the chest. This form 
is best developed in healthy adult females. 

In children the respiration is chiefly abdominal 
in type, irrespective of sex, and it is not until just 
before the age of puberty that the movements in 
the female change, becoming superior costal. Con- 
sequently, in estimating the number of movements 
per minute it is best to place the fingers lightly on 
the upper abdomen. The count should always be 
made by the watch, the most convenient time for 
the observation being while the child sleeps. 

Soon after birth the number of movements per 
minute is 44, between the ages of two months and 
two years, 35, and between two and twelve years, 
23. During sleep the frequency is reduced about 
twenty per cent. 

Children under two years, while awake, breathe 
unevenly and irregularly; there are frequent pauses 
followed by hurry and precipitancy, and some of 
the movements arc shallow, others deep. In sleep 
there is greater regularity. After the second year 
the movements become steady and even, like those 
of adults. All children, however, but particularly 



32 HYGIENE OF THE NURSERY 

the very young, are subject to a great increase in 
the rapidity of respiration under the excitement of 
muscular movement and mental emotion. 

Perfectly healthy children breathe through the 
nose, and so softly that it is necessary to place the 
ear close to the face to hear the breezy sound of 
the ingoing and outgoing air. 

Examples of Variations in Disease. — Accelerated 
breathing occurs during the course of diseases at- 
tended by severe fever. Acute affections of the 
lungs are especially characterized by this alteration, 
and the more the breathing area is lessened the 
greater is the increase. Thus, in pneumonia, 60, 
80 or 100 movements a minute are not at all un- 
usual. To speak broadly, rapid breathing may be 
caused by an elevation in the body temperature, 
by an interference with the blood aeration, and by 
thoracic or abdominal pain. 

Diminished frequency — the movements being 
reduced to 16, 12, or even 8 in the minute — is en- 
countered in certain brain affections — namely, in 
chronic hydrocephalus, and the later stages of 
tuberculous meningitis. In such cases the rhythm 
may be greatly altered — a tidal form being assumed, 
in which the breathing ebbs and flows, beginning 
with an act which is scarcely perceptible or audible, 
gradually growing deeper until a full, noisy respi- 
ration is made, and then slowly subsiding into a 



THE FEATURES OF HEALTH 33 

period of absolute quiet, variable in its duration. 
This is termed Cheyne-Stokes respiration. 

A dry, hissing sound, or a moist sound of snuf- 
fling, indicates partial obstruction of the nasal 
passages; oral respiration shows their complete 
occlusion. 

Yawning, one of the modifications of the re- 
spiratory act, if it recur frequently, denotes great 
failure of the vital powers and is an unfavorable 
prognostic element. 

12. The Pulse. — To obtain any reliable data 
from the pulse it must be felt during perfect quiet. 
During sleep is the best time, but if the child can- 
not be caught in this condition, advantage may be 
taken of its placidity while feeding or amused by a 
toy. With very young infants it is sometimes 
impossible to feel the beat of the artery at the wrist, 
and it is necessary to ascertain the frequency of the 
pulse by listening to the heart. After the second 
month feeling the pulse at the wrist in the ordinary 
way is not difficult. 

The child's pulse differs from the adult's in 
being much more frequent, more irregular, and 
more irritable. 

The frequency, or the number of beats per 
minute, varies with the age. The following is the 
average rate: 



34 HYGIENE OF THE NURSERY 

From birth to 2d month 160 to 130 

From 2d to 6th month 130 to 120 

From 6th to 12th month 120 to no 

From 1st to 3d year no to 100 

From 3d to 5th year 100 to 90 

From 5th to 10th year 90 to 80 

From 10th to 12th year 80 to 70 

These figures represent the pulse in a waking, 
but passive state. During sleep the frequency is 
less. Thus, between the second and ninth years 
there are about sixteen beats less per minute while 
asleep than when awake; between the ninth and 
twelfth years, eight less; and between the twelfth 
and fifteenth years, only two less. Below the age 
of two years the disparity is even greater. 

The irregularity of the pulse in childhood is 
confined to an alteration of the rhythm, in other 
words, of the intervals at which the beats succeed 
each other and the relative strength and volume of 
each beat. It is most marked in infants and is 
greatest during sleep, when the pulse is lowest. 

The feature of irritability, that is, the facility 
with which the frequency is increased by muscular 
activity and mental excitement, is greater in pro- 
portion to the youth of the child. A rise of 20, 30, 
or even 40 beats a minute is not uncommon in 
early infancy, under the excitement of the slightest 
effort or disturbance. 

Examples of Variations in Disease. — On account 



THE FEATURES OF HEALTH 35 

of the wide variations in health, little meaning 
need be attached to alterations of the rhythm and 
frequency while unassociated with other abnormal 
features. When so associated they become impor- 
tant in determining the existence of disease. 

Increased frequency is a constant attendant of the 
febrile state. The extent of the increase corre- 
sponds with the degree of elevation of temperature, 
though the pulse curve always runs higher than the 
temperature curve. As a rule, the more frequent 
the pulse the higher the fever. In estimating the 
risk of the increase, however, the law of the fever 
in question must be taken into consideration. For 
example, in scarlet fever a pulse of 160 is usual 
and not indicative of special gravity. In measles, 
the same degree of acceleration would be abnormal 
and show great danger. 

Jaundice and inflammation of the kidneys are 
accompanied by a diminution of the pulse rate. 

Irregularity is met with in diseases of the brain 
and heart, and sometimes in nervous and blood- 
impoverished children. 

13. The Temperature. — By placing the hand 
upon the surface of the body we can readily detect 
marked variations in the temperature; thus the 
nose and extremities feel cold in diseases associ- 
ated with depression of the vital forces, and the 
palms of the hands and back of the head feel hot 



36 



HYGIENE OF THE NURSERY 



in those attended by fever. But the only possible 
means of detecting slight variations or of obtain- 



98. 5 normal mark. 



Index, read from top, 
stands now at 98.5°. 



Clinical Thermometer. 



ing reliable information concerning normal or ab- 
normal body-heat is by the employment of an 



THE FEATURES OF HEALTH 37 

accurate thermometer. Clinical thermometers, as 
these instruments are called, are made entirely of 
glass, and are usually furnished in the shape seen 
in Fig. 4. 

This instrument is graduated according to the 
Fahrenheit scale and provided with a self-register- 
ing index, which is simply a short column of mercury 
separated from that in the bulb of the thermometer. 

Temperature is usually taken in the rectum of 
the infant or young child, and in the mouth of a 
child old enough to understand the purpose of the 
procedure, and to obey directions to keep the lips 
closed, the tongue over the bulb of the instrument, 
and to avoid breaking the glass by the forcible 
closing of the teeth. 

Supposing the rectum be chosen as the place of 
observation, it is first necessary to be sure that this 
portion of the gut is free from faeces. The upper 
end of the stem of the thermometer is then held 
between the thumb and finger, and the index, by 
a few vigorous shaking movements, is forced down 
so far that its upper extremity will be well below 
the normal mark, to 95 for instance; next, the bulb 
is covered with sweet oil or vaseline and gently 
inserted through the anus into the rectum for a 
sufficient distance to conceal completely the mer- 
cury. Here it is allowed to remain, according to the 
sensitiveness of the instrument, from one-half to two 



$8 HYGIENE OF THE NURSERY 

or even five minutes by the watch, and on being 
removed the degree of temperature is read from the 
top of the index. The position of the patient in the 
meanwhile is upon the back, on the nurse's lap, 
with the legs elevated and controlled by her left 
hand, the right hand being used in steadying the 
thermometer. 

When taking the temperature in the mouth direct 
the child to lie down on his back and instruct him 
not to bite upon the delicate glass. Then, having 
seen that the instrument is thoroughly clean and 
that the top of the index is below the normal point, 
insert the bulb, crosswise, beneath the tongue. The 
teeth must be lightly closed so as to hold it in 
position, and the lips closely shut about its stem. 
For the time necessary to complete the observation 
breathing must be performed entirely through the 
nose. 

Temperature is also taken in the arm-pit and 
groin, but the observation in these positions is inac- 
curate and unreliable. 

One more fact is important, namely, that a simul- 
taneous observation in the different positions men- 
tioned will not furnish identical results; the rectal 
and oral temperature being, normally, at least i° 
higher than that of the arm-pit, and 1.5 higher 
than that of the groin in the same individual. 

When properly used the thermometer is of great 



THE FEATURES OF HEALTH 39 

value in the nursery. At the same time, under oppo- 
site conditions, it may be the source of much unnec- 
essary alarm to overanxious parents. To prevent 
the latter misfortune, all who intend to use the 
instrument should be familiar with the healthy 
range of temperature and some of the characteristic 
variations in disease. 

During the first week of healthy life the temper- 
ature fluctuates considerably. After this the pu- 
erile norm — 98. 5 to 99 F. — is established, but 
until the fourth or fifth month it is greatly influenced 
by physiological causes of variation, the fluctuations 
ranging between .9° and 3. 6°. By the fifth month 
regular morning and evening oscillations begin to 
be noticeable, and certain definite laws are followed. 
Thus there is a fall in the evening of i° or 2 . The 
greatest fall occurs between 7 and 9 p. m., and the 
minimum is reached at, or before, 2 a. m. After 
2 a. m. there is a gradual rise, the maximum being 
reached between 8 and to a. m. Throughout the 
day the oscillation is trifling. These variations are 
independent of eating and sleeping. 

It may be taken for granted, therefore, that a 
temperature between 98 and 99 in the morning 
and 97. 5 and 98. 5 in the evening is the range to 
be expected in a healthy child beyond the age of 
five months. 

Examples of Variations in Disease. — In disease 



4<0 HYGIENE OF THE NURSERY 

there may be either a rise above or a fall below the 
normal standard. 

Fever is always associated with an elevation. 
Rapid and transient rises attend slight catarrhs 
and passing indigestions. Prolonged rises indicate 
inflammatory and essential fevers, for example, 
typhoid, scarlet fever and measles. 

The degree of elevation marks the type of the 
fever. This is moderate when the mercury stands 
at io2°, severe at 104 or 105 , and very grave 
above 107 . It is known, however, that infants 
are extremely sensitive to conditions productive of 
fever, and that, in them, the temperature, like the 
pulse, is easily influenced by slight and transient 
causes: therefore, a high degree of temperature, 
io4°-io5°, in young children is less alarming than 
in adults, and of less import than a continuance of 
the elevation, in estimating the gravity of a fever. 
The duration of the elevation and the peculiar 
range of the oscillations (for there are oscillations 
in disease as well as in health) determine the 
nature of the fever. The febrile oscillations differ 
from the healthy, in that the lowest marking is 
noticed in the morning, the highest in the evening. 

Variations in the typical range of any given fever 
are important prognostic omens: a sudden fall of 
the temperature, together with improvement in 
the general symptoms, indicates the beginning of 



THE FEATURES OF HEALTH 41 

convalescence; a similar fall, with an increase of 
the general symptoms, is a precursor of death. 
When the morning temperature is equal to that of 
the preceding evening, there is great danger; if 
higher, greater danger still. Marked remission in 
continued fevers is generally a forerunner of con- 
valescence. 

Abnormal depression of temperature is occasioned 
by hemorrhage and by the loss of fluids in cholera 
infantum or entero-colitis. It is also met with in 
anaemia, in wasting from insufficient nourishment, 
in diseases of the heart and lungs attended by im- 
perfect oxidation of the blood, and it constantly 
attends collapse and the death agony. A main- 
tained temperature of 97 is dangerous in children, 
and for every degree of reduction below this the risk 
for life is more than proportionately increased. 

14. The Mouth and Throat. — In infants, gentle 
pressure of the fingers upon the chin is sufficient to 
cause wide opening of the mouth. An older child 
will frequently open the mouth when requested, 
but if he refuses, the finger, or, far better, the 
handle of a spoon, or some other smooth, flat instru- 
ment, may be inserted in the mouth, and downward 
pressure made upon the tongue, when the jaws will 
be widely separated. In some cases, when the child 
is old enough to do as he is bid, the fauces can be 
seen by directing the mouth to be opened wide and 



42 HYGIENE OF THE NURSERY 

the tongue to be alternately protruded and retracted, 
or a prolonged sound of U ^4A" to be made. With 
the refractory, and always with infants, the tongue 
has to be held down by a spoon-handle or tongue- 
depressor. If there be resistance, the patient must 
be taken on the lap of the nurse, who holds his 
back against her breast, directs his face toward a 
bright light, and controls the movements of his 
hands and feet. 

The healthy oral mucous membrane has a deep 
pink color, and is smooth, moist and warm to the 
touch. The color is deeper on the lips and cheeks, 
lighter on the gums. The latter, up to the sixth 
month, as a rule, have a moderately sharp edge. 
Subsequently, the edge begins to broaden and 
soften, and the color of the investing mucous mem- 
brane deepens to a vivid red, and becomes hot, as 
the teeth begin to force their way through. 

The tongue should be freely movable. It is 
pink in color, and the dorsum or upper surface, 
marked in the centre by a slight longitudinal depres- 
sion, has a velvety appearance, and is soft, moist and 
warm to the finger. The velvety nap is due to the 
numberless hair-like processes of the filiform papil- 
las. There are also scattered over the surface, but 
most closely at the tip, a number of eminences, the 
size of a small pin's head, circular in outline, and 
deeper pink than the general surface — the fungi- 



THE FEATURES OF HEALTH 43 

form papillae. While far back, defining the papil- 
lary layer, are the circumvallate papilla?, numbering 
about twelve, and arranged in a V-shaped row. 
These have the form of an inverted cone, sur- 
rounded by an annular elevation. 

The hard palate, or roof of the mouth, is rough- 
ened anteriorly by transverse ridges. The soft 
palate — its continuation — is smooth, and its mucous 
membrane is paler than that of the rest of the mouth. 
The fauces, or walls of the throat, on the contrary, 
are redder. In the triangular recess between the 
half arches of the palate the tonsils can always be 
seen. They should be about the size and shape of 
almond kernels, and they present a number of cir- 
cular openings, the orifices of pouches, into which 
the follicles open. The uvula — or, in popular lan- 
guage, the palate — is short and tongue-shaped. 
The posterior wall of the throat should be red, 
smooth and moist. 

Examples of Variations in Disease. — Fever makes 
the mouth hot and dry, and causes the tongue to be 
frosted or coated. Affections of the stomach and 
bowels arc usually attended by coating of the tongue. 
Inflammation of the mouth itself reddens the 
lining membrane, makes it hot and tender to 
the touch, increases its moisture, alters the surface 
of the tongue and leads to the formation of aphthae 
and to ulceration. 



44 



HYGIENE OF THE NURSERY 



15. Dentition. — Normally, the first or "milk 
teeth," twenty in number, are cut in groups, each 
effort being succeeded by a pause or period of rest. 
The diagram and table following show the group- 
ing, the date of eruption, and the duration of the 




Fig. 5. — Diagram Showing Eruption of Milk Teeth. 
1, Between the 4th and 7th months. Pause of 3 to 9 weeks. 2222, 
Between the 8th and 10th months. Pause of 6 to 12 weeks. 
3 3 3 3 3 3, Between the 12th and 15th months. Pause until the 18th 
month. 4444, Between the 18th and 24th months. Pause of 2 to 
3 months. 5555, Between the 20th and 30th months. 



pauses, the numbers, i to 5, indicating the groups 
to which the individual teeth belong and their order 
of appearance, and the letters a and b the prece- 
dence of eruption in the different groups (Fig. 5). 

The pauses are, to say the least, most helpful, 
giving the infant's system an opportunity to rest 



THE FEATURES OF HEALTH 45 

after each effort, to recover from any coincident ill- 
ness, and to prepare for the next strain. 

The dates here given show the time within 
which the different teeth naturally may be expected. 
In regard to the period given for the eruption of the 
lower central incisors, I would state that the fourth 
month, although an early is not a very rare time 
for their appearance. For example, I have seen 
during one winter five cases in which these teeth 
pierced the gum at this age. 

Often the teeth appear without the production of 
any symptoms. Sometimes the edges of the gums 
lose their sharpness and become swollen, rounded, 
and reddened as the teeth approach the surface. 
At the same time the saliva is increased in quantity, 
and the mouth is unnaturally warm and the seat of 
abnormal sensations, evidenced by the tendency 
to bite upon any object that comes to hand — in 
other words, there is a condition of mild catarrhal 
stomatitis. The consequent discomfort is not suf- 
ficient to interfere with the child's appetite, good 
humor, or sleep, and when, after a few days, the 
margin of the tooth is free, all the local symptoms 
vanish. 

Examples of Variations. — Abnormal dentition is 
manifested by departures from the laws if develop- 
ment already stated. The standard rules may be 
departed from in three ways: 



46 HYGIENE OF THE NURSERY 

i . The appearance of the teeth may be premature. 
Children may be born with one or more of their 
teeth already cut; these are usually imperfect, and 
soon fall out, to be replaced, at the proper age, by 
well-formed milk teeth. Sometimes, however, they 
remain permanently, as in a case that came under 
my own observation. Natal teeth are always 
incisors. Instances of the lower central incisors 
being cut in the third month are not uncommon. 
Girls are more apt than boys to cut their teeth 
early, and, as an early dentition is likely to be an 
easy one, the occurrence is to be looked upon as 
fortunate. 

2. Dentition may be delayed. This deviation is 
more frequently seen and of more consequence than 
the first. Bottle-fed babies, as a class, are more 
tardy in cutting their teeth than those reared at the 
breast. With such, though healthy in every re- 
spect, a delay of one or two months is a common 
and not at all serious event. On the contrary, 
whatever the method of feeding, if no teeth have 
appeared by the end of a year, it may be assumed 
that the child's general nutrition is faulty, or that 
rachitis is present. Delay does not necessarily 
imply difficulty in cutting the teeth, although the 
two conditions are often associated. 

3. The teeth may appear out of their regular 
order. Bottle-fed infants are most likely to show 



THE FEATURES OF HEALTH 47 

this irregularity, which is of some importance as an 
indication of general feebleness. In other instances, 
however, it is merely a family peculiarity, and, as 
such, bears no special significance. 

The order of eruption of the permanent teeth is 
as follows: 

The two central incisors of lower jaw, from 6th to 8th year. 

The two central incisors of upper jaw, from 7 th to 8th year. 

The four lateral incisors, from 8th to 9th year. 

The four first bicuspids, from 9th to 10th year. 

The four canines, from 10th to nth year. 

The four second bicuspids, from 12th to 13th year. 

These replace the temporary teeth; those which 
are developed de novo appear thus: 

The four first molars, from 5th to 7th year. 
The four second molars, from 12 th to 13 th year. 
The four third molars, from 17th to 21st year. 

There are, therefore, twelve more permanent 
teeth, making thirty-two in all, sixteen in each jaw. 

The diagram, Fig. 6, will aid in explaining the 
process. 

As these teeth approach the surface, absorption 
begins in the alveoli and at the roots of the deciduous 
teeth, and this continues until the latter are loosened 
and readily extracted, or if this be not done, until 
little is left but their crowns. 

When the first and second molars approach the 
surface, the gums, just as in primary dentition, 



4S 



HYGIENE OF THE NURSERY 



may become red, swollen, rounded, and tender. 
The salivary secretion is increased, the mouth is 
hot, the patient complains of aching in the gum, 
and, on account of tenderness, refuses food requir- 
ing mastication. With the other sets there is a 
gradual loosening of the superimposed temporary 




6 4- 2 2 * ~ b 
Fig. 6. — Diagram Showing Relation Between Permanent and 

Temporary Teeth. 

The figures i, 2, 3, etc., indicate the groups of teeth and the order of their 

appearance. 

teeth, pain on mastication, redness and tumefaction 
of the gum, and augmented flow of saliva. As 
there is no impairment of the general health, these 
trifling symptoms must be regarded merely as 
manifestations of the progress of a physiological 
process. 



THE FEATURES OF HEALTH 49 

In concluding this subject it is important to em- 
phasize the fact that many diseases occurring in 
infancy were formerly attributed to dentition, but 
as the affections of early life have been more care- 
fully studied and better understood, one disorder 
after another has been relegated to its proper etio- 
logical class, and teething is now regarded as a 
purely physiological process, unproductive of symp- 
toms. All that can be said is that the interval be- 
tween the fourth and thirtieth months of an in- 
fant's life — the period of primary dentition — is an 
era of great and widely extended physical progress. 
The teeth are advancing; the follicular apparatus 
of the stomach and intestinal canal is undergoing 
development in preparation for the digestion and 
absorption of mixed food; the cerebrospinal system 
is rapidly growing and functionally very active, and 
the organs and tissues of the whole body are in a 
state of active change. This period of normal 
transition must also be one in which there is great 
susceptibility to abnormal change, or disease, pro- 
vided there be a causal influence at work. Such an 
influence usually originates outside of the body, as 
when there is exposure to cold or to contagion. 

Second dentition has perhaps a greater but still a 

merely indirect effect upon the health. During this 

process the loss of teeth and the local irritation of 

the gums interfere materially with mastication of 

4 



50 HYGIENE OF THE NURSERY 

the older child's solid food, and digestion and 
nutrition being consequently impaired, the general 
health suffers and there is less resistance to the 
various external causes of disease. The approach 
of puberty at this time also puts an additional strain 
on the system. 



CHAPTER II. 

THE NURSERY. 

Every well-regulated house in which there are 
children should be provided with two nurseries, 
one for occupation by day, the other by night. 

Before entering further into the subject, how- 
ever, attention must be directed to the fact that the 
American city-bred child, belonging to the class in 
which it is possible to provide separate rooms for 
nurseries, is to a greater or less degree a migratory 
creature. For when the first warm days of May or 
early June make the parents bask at open windows, 
the child is hurried off to a suburban hotel or farm- 
house or to the sea-coast. Again, as soon as the 
cold evenings of late September suggest the com- 
fort of an open fire, equal energy is exhibited to 
get him back to cozy winter quarters. In summer, 
most of the waking hours are spent in the open air, 
in winter, the greater proportion indoors; hence 
the day nursey must be regarded as a winter resort, 
and as such must possess qualities that would render 
it uninhabitable by the child in hot weather. The 
night nursery should have, though to a much less 
degree, ili<- same qualities. In other words, to put 
51 



52 HYGIENE OF THE NURSERY 

the whole subject concisely, the nurseries for winter 
use should be warm and freely exposed to the sun; 
for summer use, cool and rather shaded, though 
always perfectly dry. 

Since the child spends so much time in the open 
air during warm weather, the nurseries will be dis- 
cussed in this chapter purely from their winter 
standpoint, and will be described under the follow- 
ing heads: 

Situation. — Any room in the house will not do 
for a day nursery. Rather, on the contrary, must 
the best room be selected. It should have a south- 
west exposure, and be, if possible, so situated in 
the building as to allow of at least two broad win- 
dows, one in the southern end and one in the western 
side, and these windows must always be strongly 
barred. Into such a room the sun plays with full 
force from a few hours after rising until nearly the 
time of setting. The third floor of a house is a 
better elevation for the nursery, especially if there 
be an attic above, than either of the lower floors, 
partly because such rooms are remote from the 
ordinary domestic disturbances, but chiefly because 
they are drier and more readily heated, and being 
elevated are less cut off from sunlight by surround- 
ing buildings. 

The night nursery should, if possible, adjoin and 
communicate with the day nursery, although this 






THE NURSERY 53 

feature is less important than proximity to the 
parents' sleeping-room. It should have a good- 
sized window so placed that it will freely admit 
sunlight during the day. 

When the nurseries connect, the opening of 
communication must be capable of being com- 
pletely closed by a well-fitting door or folding doors, 
so that one room may be thoroughly aired with- 
out chilling the other. 

Neither apartment ought to communicate with 
a bath-room having sewer connections; in fact, 
although it may be an object of complaint from the 
nurse, the further off such a bath-room is the better 
for the health of the child. 

While it is a matter of difficulty to accomplish 
in an ordinary city house, it is, nevertheless, a 
necessary thing to have the nurseries in close prox- 
imity to, or even in communication with, the apart- 
ment in which the parents sleep; for then the nurse 
is forced to be morally purer and physically more 
attentive than if she have a section of the house to 
herself. 

Many mothers prefer to keep their children at 
night. Under this condition, the bedroom becomes 
the night nursery, and its situation must be as care- 
fully selected, and its hygiene as particularly guard- 
ed, as the regular night nursery. When, too, there 
are several children in the family, the risk of over- 



54 HYGIENE OF THE NURSERY 

crowding in such apartments must be recognized 
and carefully guarded against. The factor of dis- 
turbed rest, by the different hours of retirement of 
children and parents, is also one of importance. 
On all of these accounts a night nursery, under the 
control of a competent nurse, is, in my opinion, to 
be preferred. 

Size.— The amount of atmospheric air required 
by a healthy child to accomplish thorough oxida- 
tion of the blood in respiration is about the same 
as that demanded by adults. Therefore the small- 
est admissible room for either a day or night nur- 
sery for a single child must have a capacity of 
eight feet cube. For more than one child the rule 
ordinarily given is, to multiple this figure — eight 
feet cube — by the number of individuals. This 
rule works well enough for a family of two or three 
children, but if the number be greater, the size of 
apartments required would much exceed any that 
could be found in ordinary houses. Lack of space, 
then, must be made up by more perfect methods 
of ventilation. To put the question in a more 
practical form, a room nine or ten feet high, twenty 
feet long and fifteen feet broad will readily accom- 
modate, either for playing or sleeping purposes, 
two or three children, with one attendant, pro- 
vided foul air be constantly removed and fresh air 
supplied by ventilation. 






THE NURSERY 55 

In every room the undermost stratum of air, and 
the one in which the child must pass the greater 
part of his time, whether awake or asleep, has a 
much lower temperature than the middle, and this, 
again, than the highest, the tendency of the heated 
air being always to rise to the top. Now, the 
greater the height of the apartment, the cooler will 
be the floor and its neighborhood; consequently, a 
lofty ceiling— namely, one over ten, or, at most, 
twelve feet — while it makes an imposing show, is 
far from being desirable for a nursery, where ease 
of heating and the comfort and health of the occu- 
pants are the ends to be attained. On the other 
hand, a ceiling less than eight feet high will tend 
to make the room close, stuffy and overwarm, and 
correspondingly unhealthy. 

Lighting. — As already indicated, the only per- 
missible light for a day nursery is that derived from 
the sun, and the more plentiful this is, and the more 
directly it enters, the better. The night nursery 
may be illuminated by electricity, by gas, by an oil 
lamp, by a candle, or by a night light. Older writers 
recommend the last three, upon the supposition 
that gas, while burning, not only consumes a con- 
siderable proportion of the oxygen of the air, but 
gives off certain injurious products of combustion. 
This may be true to a certain extent, but the dis- 
advantages are greatly discounted by the increase 



56 HYGIENE OF THE NURSERY 

in convenience and the greater safety, so far as 
causing fire is concerned. 

Gas, or much better, electricity, certainly may be 
used in the late afternoon and evening. During the 
night hours, should a light be constantly required, 
the best means of obtaining it is from one of the 
regular night lights. 

A very admirable form of such a light is shown 
in Fig. 7. This light, called the "Pyramid Night 




Fig. 7. — Night Light. 

Light," consists of a low brass stand having a 
movable pyramidal glass chimney, and provided 
with a porcelain cup upon which the candle rests. 
The candle itself is about one inch and a half in 
height and breadth, and is so constructed that the 
combustible material is completely incased in a 
fireproof plaster-of-Paris cup. Each candle will 
burn eight or ten hours. These lights are perfectly 



THE NURSERY 57 

safe and may be utilized for the further purpose of 
keeping water warm. 

For occasional use at night, nothing can be 
better or of more ready service than electricity or gas. 

The safest way to make a light is to use a safety- 
match. The taking of a flame from an open fire 
or the use of ordinary friction matches are danger- 
ous and to be strongly discouraged. 

Furnishing. — This heading may be made to 
include the finish of the floor, walls and ceiling, as 
well as the necessary articles of furniture and their 
arrangement. 

The floor, which ought to be laid with good 
yellow pine boards, should have a hard finish. To 
accomplish this, the crevices between the boards 
and all the nail holes must first be filled with putty, 
then, after this has dried, coated with a rapidly- 
drying, hard shellac varnish, next sandpapered, 
when the varnish has had time to harden thor- 
oughly, and, finally, finished by a second coat of 
shellac. This gives a light-colored floor that bright- 
ens the room and at the same time is readily cleaned. 
A dark staining, besides being sombre, always looks 
soiled. A painted floor is not easily cleaned. 
Should either of the latter be already in a nursery, 
their defects may be overcome by a well-laid 
parquet floor. 

A carpet tacked to the floor is not to be recom- 



58 HYGIENE OF THE NURSERY 

mended; far better is it to have rugs, which can be 
frequently taken up and well shaken, the house- 
maid having in the meanwhile free access to the 
floor itself. 

Paint is the best finish for the walls. Individual 
taste will of course weigh in the selection of the 
color and amount of decoration, though a light tint, 
but still one not trying to the eyes, is most desirable. 
Next to paint, varnished paper is to be preferred. 
Within the past few years light and soft-tinted 
fabrics, covered with the representations in figure 
of familiar nursery legends, have been for sale by 
paper dealers. Such papers render the nursery 
attractive to older children, and, to a great extent, 
take the place of pictures. Paint, however, has the 
advantage, in that it may be washed and thoroughly 
disinfected in case of the occurrence of contagious 
disease. 

To return to the subject of pictures, it is best to 
interdict any that are valuable or expensively 
framed. A few well-colored, striking, prints taken 
from one of the good weekly illustrated papers, 
and fixed to the painted wall by glue, will give as 
much pleasure to the childish eyes as the works of 
the best artists. They can, too, be changed from 
time to time, and after exposure to contagious germs 
may, without regret, be removed and burned in the 
process of cleaning. 



THE NURSERY 59 

The ceiling of the rooms should always be painted 
with some light color, and be perfectly free from 
ornamentation. 

In the matter of furniture, the windows of the day 
nursery should be fitted with dark shades, but 
never with curtains or hangings. In summer when 
the windows are often open, they must be carefully 
screened to keep out insects, especially mosquitoes 
and flies. These not only annoy the child, but the 
mosquito may introduce the germ of malaria or 
poison with its sting, and the feet of the fly may 
carry the germs of such diseases as typhoid fever, 
diphtheria or tuberculosis. Other furnishings are : 
a table, at which the older children may take their 
meals or use in play and study; one or more large 
chairs and several small ones; a plentiful supply 
of toys and picture books, and, if there be room 
enough, a chest of drawers or wardrobe for clothing, 
and so on. All the furniture must be plain, that 
it may be more easily kept clean. 

The center of the room must be kept clear, to 
give an opportunity for play. The table, therefore, 
should be a folding one, that it may be placed out 
of the way against the wall and take up the least 
space possible when not in use. Any other heavy 
article of furniture must also occupy a position 
against the wall and be fitted with casters, so that 



60 HYGIENE OF THE NURSERY 

it can be readily moved to facilitate cleaning the 
floor beneath. 

The toys may vary in character with the age of 
the child — soft, white India-rubber ones for infants, 
more complicated mechanisms for older children; 
but inexpensive toys are the best, because they can 
be more frequently changed. The same is true of 
books. For both, by the way, there should be a 
special drawer or closet provided, where they can 
be put out of the way when not required. 

A few plants, a bird, or a globe of fish add bright- 
ness to the child's room and greatly assist in culti- 
vating good taste and in affording amusement. 

The night nursery must contain the beds, the 
bathing and toilet utensils, several chairs — one 
being a rocker— a small table, a medicine closet 
and a chest of drawers or other convenient recep- 
tacle for clothing and extra bed covering. 

It is essential to have a separate bed for the nurse 
and one for each child. They should be placed so 
as to be protected from any chance draught of air, 
be far enough apart to allow of a free passage be- 
tween; and the bed of the youngest, or of an ill child, 
ought to be nearest the one belonging to the nurse. 
About these beds nothing that may not be washed 
can be allowed. 

Old-fashioned pitchers and basins are to be pre- 
ferred to stationary washstands. The latter, though, 



THE NURSERY 6 1 

are so convenient— especially when supplied with 
hot- and cold-water faucets — that they may be per- 
mitted when the waste pipe is short and runs directly 
through the wall into a rain spout, instead of com- 
municating with the sewer, and when the nurse 
can be trusted not to use them as a convenient 
means of disposing of the ordinary chamber 
waste. 

Each child should have his or her own brushes, 
combs, sponges, soap and towels, and all of them 
must be kept clean and sweet and have a place of 
their own. 

The medicine closet must contain only such 
articles as may be often required, and can be used 
with safety by a person of average intelligence; for 
example, olive oil, vaseline, oxide of zinc ointment, 
talcum powder, soda-mint, sweet spirits of nitre, 
syrup of ipecacuanha, chalk mixture, etc. Any 
preparation containing opium — even paregoric — 
is especially out of place in the nursery medicine 
chest. 

Feeding bottles, implements for the heating and 
preparation of food and for bathing, also belong to 
the furniture of the nurseries, but their consideration 
may be conveniently postponed to later sections. 

Heating. — Each room requires an accurate ther- 
mometer, so hung that it may record the mean tem- 
perature — not too close to the fireplace or the win- 



62 HYGIENE OE THE NURSERY 

dows, where it runs the chance of being unduly 
heated or chilled. 

The temperature of the day nursery should range 
between 68° and 70 F. ; that of the night nursery 
from 64 to 68° for infants under three months old; 
after the third month a temperature of 55 is allow- 
able, and when the child is a year old it may be as 
low as 50 or 45 . 

The proper method of heating is by an open fire- 
place in which either wood or coal is burnt. Either 
of these fires is superior to a furnace, simply because 
they serve a double purpose, namely, heating and 
ventilating. My personal preference is for an old- 
fashioned hearth, where oak or other quietly burn- 
ing logs can be used, since a wood fire is more 
readily lighted and regulated, and is a better venti- 
lator than one of coals. Still, in our climate, with 
its manifold and sudden changes, it is so essential 
to have a source of heat constantly at hand that it 
is difficult to banish the furnace register from any 
living room. Therefore, while recognizing the dis- 
advantage of furnace heat, in that it makes the air 
too dry, it is well to supply the nurseries with both 
means of heating, using the open fire in moderate 
weather and the furnace only in the presence of 
severe cold. For general heating the modern hot- 
water radiating system is to be much preferred to 
the old hot-air furnace and to steam heating; with 



THE NURSERY 63 

it, an even temperature is easily secured without 
over-drying the air of the house, or loading it with 
dust and coal-gas. 

In my experience, where the nurseries are so 
situated as to receive direct sunlight through ample 
windows, there is rarely any need of furnace heat 
except in the early morning, before the servants 
have time to make up the wood or coal fire. 

Care must be taken to guard every open fireplace 
with a high fender, one that can neither be knocked 
down nor climbed over by an active child. 

Ventilation. — In addition to furnishing ample 
space in the nurseries, it is necessary to provide a 
constant supply of fresh air by ventilation. 

By all odds the best ventilator is an open fireplace 
in which wood is burnt. Such a fire, by creating a 
draught up the chimney, carries off the impure air, 
and there are few doors and windows so closely 
fitting that they prevent the entrance of fresh air 
to supply the place of that so removed. 

Should this not prove sufficient, one of the windows 
may be utilized, the upper sash being slightly 
lowered and the lower sash slightly raised, the open- 
ings being sufficient to allow of the entrance and 
exit of air, but not enough to cause a current or 
draught in the room. 

When the rooms are heated by a furnace or stove, 
some permanent ventilator must be used. For the 



6 4 



HYGIENE OF THE NURSERY 



egress of foul air an opening may be made in the 
chimney at a convenient distance from the floor; 
this may be guarded by an ordinary adjustable 
register, such as is used to regulate the entrance of 
heated air from a furnace flue. 

The same purpose may also be accomplished by 
making an opening in the upper part of the door. 
This should be guarded by a movable sash, or by 
one of the ventilating appliances to be mentioned 
later. 




Fig. 8. — Window Ventilator. 



To allow of the free entrance of pure air, one of 
the glass lights may be replaced by a plate of tin 
having a multitude of minute perforations, or a 
ventilator made to fit the window may be used. 

The best of these are shown in the four following 
figures. 

One apparatus (Fig. 8) consists of two pieces of 
board, one of which slides upon the other, so that 
it may be readily adapted to any breadth of win- 



THE NURSERY 



65 



dow frame. Each portion has a circular opening 
to which is fitted a tin or sheet-iron pipe, eight 
inches long by four inches in diameter, and having 
a slight upward bend. These pipes are provided 
with a solid diaphragm (Fig. 9) readily moved by a 
handle, and intended to regulate the quantity of air 
admitted. When in position the pipes, of course, 
project inward. 




Fig. 9. — Window Ventilator in Profile Showing Damper. 



The wheel window ventilator (Fig. 10) consists of 
a movable diaphragm and a revolving wheel, the 
whole varying from six to eight inches in diameter. 
When placed in position, which is readily done by 
cutting a circular hole in a window pane or in the 
door, the difference in temperature between the 
Ulterior and exterior of the room will create a 
current, and cause the wheel to revolve noiselessly. 

5 



66 



HYGIENE OF THE NURSERY 



The revolving wheel, while it prevents a draught, 
allows of the passage of two currents, that of fresh 
air inward and foul air outward, and the diaphragm 
enables one to control the supply of air. 




Fig. io. — Wheel V 



ENTILATOR. 



Fig. 



-Board Ventilator in Place. 



An admirable domestic arrangement for ventila- 
tion consists of a board eight or ten inches in height 
placed across, and close to, the window sill, as in 
Fig. ii. 



THE NURSERY 67 

This, when the lower sash is raised, as indicated 
by the dotted lines, allows of a free entrance of air 
without a draught, the current being directed up- 
ward (as shown by the arrows). 

Together with the above careful provision for 
constant purification of the atmosphere, it is essen- 
tial to "air" thoroughly both of the nurseries through 
widely opened windows. With the day nursery 
this must be done whenever the child leaves it for 
any length of time, care being taken to close the 
windows and get the temperature to the proper 
degree before his return. The night nursery should 
be aired after the children leave it in the morning, 
and after the midday nap. 

The air of the nurseries should, of course, never 
be unnecessarily contaminated. Cooking or smok- 
ing in the rooms is to be specially avoided. In 
regard to the latter, there is no doubt that children 
are often made sick by the fumes of tobacco, and 
that, of all forms, cigarette smoke is the most in- 
jurious. 

Cleaning. — It is hardly necessary to say that the 
nurseries must be kept perfectly clean. Napkins 
and bed clothing that have been soiled by the dis- 
charges from the bladder or bowels must be re- 
moved at once from the room, and the practice of 
hanging diapers wet with urine before the nursery 
fire to dry should be emphatically discouraged. 



68 HYGIENE OF THE NURSERY 

Equal care must be taken to promptly empty and 
clean chamber vessels after use. 

The furniture, woodwork and window glass, as 
well as the floors, must be kept clean and free from 
dust by wiping with a damp cloth at least once or 
twice a week. 

Should there be a stationary washstand in either 
room, it is most important to thoroughly clean the 
basin every day, and to disinfect the waste pipe, how- 
ever short it may be, twice every week. The latter 
may be done with ammonia, copperas or Piatt's chlo- 
rides. The process is very simple, and consists in 
pouring down the pipe a gallon or more of a diluted 
solution of either of the above articles. Copperas 
is the cheapest and in my opinion the best; a double 
handful of it in an ordinary bucketful of water 
forms an efficient disinfectant and deodorizer. 

The substance known as household ammonia 
may be employed in the strength of two table- 
spoonfuls to a gallon of water, and is especially 
useful where there is a suspicion that the interior 
of the waste pipe has become coated with a layer 
of soap. 

Piatt's chlorides is used in the proportion of one 
part to four of water, and is very efficient, though 
more expensive than either of the other materials. 
V The nurseries must never be cleaned while the 
children are occupying them. 



CHAPTER III. 

THE NURSE-MAID. 

While the mother is the natural guardian of the 
physical and moral welfare of her children, the 
nurse-maid has a considerable influence over both; 
for the former, however anxious and watchful, has 
so many other duties, both domestic and social, 
that she must absent herself at times from the 
nursery; the latter, on the contrary, lives there. 
By day, and often, too, at night, she has the care 
of the children, attending to their apartments, to 
their persons, food and clothing, participating in 
their amusements and exercise, and watching over 
their sleep. The selection of a nurse-maid, there- 
fore, is a matter of much importance. 

The celebrated Dr. West, in discussing the nurs- 
ing of sick children, makes the following statement 
in regard to a nurse's qualifications: "Indeed, if 
any of you have entered on your office (hospital 
nursing) without a feeling of very earnest love to 
little children — a feeling which makes you long 
to be with them,- to take care of them, to help 
them — you have made a great mistake in under- 
69 



70 HYGIENE OF THE NURSERY 

taking such duties as you are now engaged in." 
Now, though this was addressed to those who were 
occupied in caring for ill children, it is alike appli- 
cable to the nurse whose chief duties are with the 
healthy. 

Love of children, therefore, is essential in a good 
nurse, but it must be combined with several other 
traits of character, since love alone will not com- 
pensate for such faults as stupidity, inexperience, 
forgetfulness and lack of judgment. 

What, then, are the qualifications to be sought 
for? 

First. — The woman should be in the prime of life, 
between twenty-five and sixty, for example. For if 
she be under the former age, she is apt to be frivo- 
lous and think more of her "afternoon out" and of 
her male friends than of her charge, while if over 
the latter, besides being set in her ways and opin- 
ionated, she is usually too worn out for efficient day 
service and too prone to heavy sleeping to be trusted 
for night duty. 

Second. — Strength, activity and freedom from dis- 
ease are necessary. Consumption of the lungs, indi- 
cated by a cough, and syphilis, indicated, usually, by 
an eruption upon the skin, are two diseases to be 
specially avoided. Besides these two, which are to 
be shunned because they positively endanger the 
child's health, there are others that, without doing 



THE NURSE-MAID 7 1 

appreciable harm, render the sufferer's presence un- 
bearable in the nursery. These chiefly offend 
through the sense of smell, as in the case of old 
leg ulcers; too freely perspiring feet; overactive 
axillary glands; certain forms of chronic catarrh 
of the nose, throat or tonsils; and of decayed or 
badly kept teeth. 

Third. — While beauty is not to be specially sought 
after, the maid's face should, at least, have a cheer- 
ful expression. A markedly homely or sinister 
face is a disadvantage, and still more so is any 
decided deformity. This reference to personal 
appearance at first sight, perhaps, seems trivial, 
but any one who has seen much of children can- 
not fail to have noticed how a young child will 
crow and hold out its arms to one who has a placid, 
comely and smiling face, and turn away from one 
who wears a sombre and unsympathetic expression. 
Much is said about the magic of touch in managing 
young children, but I have observed that their eyes 
always seek the face and eyes of those about them, 
and that it is what they see there that guides their 
instinct for like or dislike. 

Fourth. — Children resemble dogs and horses as 
far as the instinct of knowing those who love them is 
concerned, and the element of love toward babies 
is, as already hinted, the most important feature in 
the disposition of a nurse. A woman having this 



72 HYGIENE OF THE NURSERY 

quality will never be cross or impatient, and, by the 
very contagion of her good nature, prevents her 
charges from being fretful and makes her nursery 
happy. Besides love, with the patience and con- 
sideration it implies, truthfulness is a most impor- 
tant trait of character, not only for the physical 
welfare of the child, but also that, since children 
are such imitative creatures, the bad habit of lying 
may not be formed. 

A truthful, loving woman is generally a cheerful 
one; if not, her place is out of the nursery, for 
children must be happy to be healthy, and the 
constant contact with sadness will bring unhappi- 
ness to any child. 

Gentle speech is also a desideratum. Children 
will never learn politeness if every sentence they 
hear in the nursery is spoken in the fewest, shortest 
words; and "please" and "thank you" are good 
elements of a nurse's conversation. 

Fifth. — The nurse-maid should have a sufficiently 
developed mind to follow out and remember gen- 
eral directions, whether given by the physician or 
mother, and to do routine work without constant 
supervision. A certain amount of experience is a 
good thing, and on this account it is recommend- 
ation for a woman to have had a partial hospital 
training, to have nursed children before, or to have 
been a mother. On the other hand, one must 



THE NURSE-MAID 73 

beware of the self-opinionated maid, who, having 
cared for several children, thinks she knows every- 
thing, and will be controlled by neither professional 
nor maternal directions. Such women are as igno- 
rant and inefficient as they are common. 

Sixth. — Cleanliness is essential in a nurse. A 
slovenly maid will keep neither her children nor 
their nurseries clean. Therefore, insist upon the 
nurse not only washing her face and hands as oc- 
casion requires, but upon her bathing her whole 
body frequently, and upon her wearing fresh, well- 
aired clothing. 

Seventh. — So far as habits are concerned, absolute 
temperance and early rising are the most desirable. 
Early rising, however, implies an early hour of 
retiring, and care must be taken to afford ample 
facilities for so doing. 

Eighth. — Every nurse-maid should be impressed 
with the importance of informing the parents of all 
conditions connected with the health of the child that 
may demand attention, and of revealing at once 
any injury that may have been sustained. 

Having selected a nurse-maid with due care, the 
mother must remember that she is not absolved 
from her duty of supervision and assistance in the 
nursery. The best of nurses will do better work, 
and be more happy and hence more useful if 
intelligently — not naggingly — overlooked, and so 



74 HYGIENE OF THE NURSERY 

assisted as not to be hurried in such necessary sup- 
plemental work as washing napkins and cleaning 
the nursery, if her meals can be taken at regular 
hours and in sufficient leisure, and if she be allowed 
reasonable time for relaxation and rest. All 
this may be accomplished if the mother will take 
charge of her child for a few hours each day, and, 
by so doing, perform a duty which is of mutual 
benefit to herself and her baby, and which should be 
nothing but an extreme pleasure. 



CHAPTER IV. 

CLOTHING. 

In introducing this subject, it may be well to call 
attention to two important points that are often 
either unrecognized or overlooked. 

First. — All children, but particularly infants, have 
little power to resist the depressing influences of 
continued cold, and on this account require warm 
clothing. 

Too much cannot be said against the fashion 
which, for the sake of supposed beauty, demands 
that children should be dressed in a way to leave 
their legs and knees bare. Even in the house, and 
except in extreme tropical weather, this barbarous 
practice is injurious, as it exposes a considerable 
part of the body to constant chilling. The physician 
knows, and the intelligent layman should be readily 
convinced of, the bad effects of such protracted 
attraction of body-heat. The explanation is sim- 
ple: every child is supplied by nature with a certain 
definite quantity of nerve force destined to be ex- 
pended each day in maintaining what physiologists 
75 



76 HYGIENE OF THE NURSERY 

term "the functions of the body," namely, breathing, 
circulation of the blood, digestion, heat-production, 
and so on. Now, if an undue proportion of this 
nerve force be consumed in producing body-heat, 
as must be the case when so large a surface is left 
bare, the other functions will be robbed of force. 
From this robbery the digestion suffers most. With 
feeble digestion comes constipation or its opposite, 
diarrhoea. Again, if the surface be chilled, the 
blood which should circulate in the skin is driven 
to the interior of the body, and the vessels of the 
mucous membrane become surcharged. This sur- 
charging, or congestion, causes the condition known 
as catarrh, which, affecting the lining membrane 
of the alimentary tract, causes vomiting and diar- 
rhoea; and, in the case of the lungs, bronchitis. 

Mothers who allow their children to have their 
legs and knees covered with the "hideous" long 
stockings or drawers, often come to me and complain 
that Mrs. So-So's children have bare legs, and are 
even healthier and more robust looking than theirs. 
Some children are born hardier than others, but 
no one knows, in the long run, how much better 
in health, in after life, are those whose vital forces 
have been husbanded and strengthened in infancy 
and childhood. I cannot waver in my opinion. I 
have been too often called to the bedside of these 
poor little "robust" children whose health, and even 



CLOTHING 77 

life, might have been spared had their clothing been 
better adapted to their tender years. One great 
argument advanced by the advocates of bare knees 
is that in olden times all children were clad with 
their arms and neck, as well as knees, bare. No 
one says how many died by the wayside. What 
mother would, on a winter's day, care to sit on the 
floor or walk through the halls with her knees un- 
covered? The mother who protests the loudest I 
have always observed to be warmly dressed herself. 

Second.— Infants and children have soft tissues. 
This statement applies as well to the bones as to 
the muscles. Therefore, the clothing should fit 
loosely, that it may not interfere with the motion of 
the limbs, with the rise and fall of the chest in respi- 
ration, or with the necessary freedom of the muscles 
of the abdominal wall or intestinal canal, one of 
which is concerned in respiration, the other in the 
no less important function of digestion. 

Let the clothing, then, be warm and loose. 

Thought for the infant's clothing must begin 
before its birth, with the filling of the "baby's bas- 
ket." This should contain the following articles: 

A nainsook slip. 

A flannel skirt. 

A merino shirt, high neck and long sleeves. 

A flannel band, twenty inches long and five inches 
wide. 



78 HYGIENE OF THE NURSERY 

A soft woolen shawl, to be used for a wrap in cold 
weather. 

Worsted socks. 

Two linen diapers. 

Large and small safety-pins. 

One pair blunt-pointed scissors. 

Powder box and puff. 

Soft hair brush. 

Cold cream or white vaseline. 

Linen bobbin. 

Two soft towels. 

Castile soap. 

Small soft flannel wash cloths, for washing face 
and head. 

Small silk sponge, for bathing body and limbs. 

Absorbent cotton for cleansing mouth, eyes, 
genital organs and buttocks. 

As soon as the child is born and the cutting of 
the cord frees it from maternal connection, it is the 
rule to wrap it in a piece of soft flannel and place 
it in a position of safety until, certain necessary 
attentions having been rendered to the mother, a 
convenient time arrives for washing. After this 
operation, which will be described on a future page, 
the child is dressed for the first time. Every infant 
requires knitted worsted shoes, or, as they are 
popularly called, "socks," a napkin and an abdom- 
inal band or "binder"; the rest of the dress — the 



CLOTHING 79 

body clothing proper — consists usually of three 
garments, which vary in pattern with individual 
ideas and tastes. 

The socks are made of silk thread or soft worsted 
yarn fashioned by needles into the shape of shoes, 
and of such a size as to fit the foot loosely, while 
covering the leg two inches or more above the ankle. 
They are held in position by a loosely tied tape or a 
narrowed band of stitches — the mechanism of which 
every knitter will understand — near the top. 
Stockings are unnecessary, and are rarely used 
before the clothes are shortened. 

The napkin or diaper may be made either of 
linen ormuslin, the former material being preferred, 
as it is less heating and less liable to cause chafing 
of the skin when wet. At first the diaper should 
be half-a-yard wide and one yard long; later, as age 
advances, larger sizes will be required. When used 
it is folded into a square and then into a triangle, 
and must be carefully adjusted to the infant's 
person so that it may not cause pain by undue 
pressure upon the back or abdomen. 

A soiled napkin can never be safely used a second 
time, even though the soiling medium be simply 
urine and the subsequent drying be thorough. In 
consequence, an abundant supply is essential. The 
least dampness renders its use dangerous, and 
while insisting upon the washing of all soiled nap- 



80 HYGIENE OF THE NURSERY 

kins, it is equally important that they be aired 
for at least twelve hours before being used again, 
that they may be surely dry. One must be most 
careful, too, to insist upon the laundress washing 
the napkins in hot suds made with a pure soap, 
and boiling for twenty minutes. No soda is to be 
used in washing, and no starch or bluing in ironing 
as the constant contact of diapers impregnated with 
irritating substances is sure to produce troublesome 
excoriation of the buttocks and neighboring deli- 
cate skin. 

The band or binder may be of fine, soft flannel or 
of knitted wool. In either case it should extend 
from the brim of the pelvis or hip bones to the lower 
ribs. The flannel band should be five inches 
wide and twenty inches long, or long enough to go 
a little more than around the abdomen; it should 
be cut on the bias to secure elasticity, should be 
unhemmed, and must be fixed in position by 
basting, not by safety-pins. This band is to be 
preferred during the first three weeks of life, for 
the purpose of holding the dressing of the cord in 
place, and to protect the navel before it is perfectly 
healed. After the cord has fallen off and the navel 
is quite normal, a binder serves merely to prevent 
abdominal chilling, and it is much better to dis- 
card the flannel band and substitute a knitted 
binder; this should be worn until the eighteenth or 



CLOTHING 8l 

twentieth month, and sometimes, if the child be 
subject to intestinal indigestion, until the fourth 
year or even longer. "Knit Abdominal Bands" 
can be purchased in the shops or any woman who 
is apt with her knitting-needles can make one, and 
the product has the advantages of being readily 
applied and of keeping its position without the aid 
of either strings or pins.* 

Several bands are required to be on hand at the 
same time for the sake of proper cleanliness, and, 
as they should be worn well into the second year, 
it is necessary to replace them, set by set, as the 
growth of the child demands. 

The body clothing is usually composed of three 
separate pieces: a shirt, a petticoat and an outside 
dress or "slip." The shirt should be long enough 
to extend from the neck to the lowest part of the 
trunk and have sleeves reaching to the wrists. It 
may be made of merino or of soft worsted yarn. 
In either case it should fit comfortably, be open from 
top to bottom in front, and be fastened by buttons, 

* Formula for Crochetted Baby-band. — Single zephyr in ridge 
stiU h, that is, half stitch, in which, going back and forth, only the 
back half of the stitches in the lower row are picked up. Begin 
on a chain of fifty and crochet forty-eight ridges, hence ninety-six 
rows. Join by a row of tight stitches or by sewing. Finish off at 
bottom by a row of plain stitches and at top by a picot-edging (five 
chains and a tight stitch back into the first). — "Babyhood," Vol. 
"I. P- 33- 
6 



82 HYGIENE OF THE NURSERY 

with a tape at the neck. The petticoat must be 
long enough to extend from the waist to six or 
eight inches below the feet. The proper material 
for the skirt is light, white flannel. This is 
gathered at the top into a muslin band, which must 
be deep enough to reach from the hips to the 
arm pits, and wide enough to lap over considerably 
at the back; it is fastened by basting or very care- 
fully adjusted small safety-pins. The overwidth is 
to allow for increase in size. 

An equally good waist can be made with arm- 
holes and buttoned in the back. 

The dress or slip is made of fine cambric, cut in 
one piece, opening well at the back that it may be 
readily slipped on and off. 

Another, and I think a preferable outfit, consists, 
also, of three garments. The first or under gar- 
ment, made of soft, white flannel, is long enough to 
extend from the neck to ten inches below the feet 
— about twenty-five inches in total measurement — 
with wide arm-holes. All the seams must be 
smooth, and the hem at the neck turned outward. 
The next garment, cut in the same way, but one- 
half inch larger, and five inches longer, is made of 
muslin. The slip is also cut Princess, has long 
sleeves, a longer skirt than either of the other gar- 
ments, and all are fastened behind by small buttons. 

When dressing the infant these three coverings 



CLOTHING 83 

are put together, sleeve fitting to sleeve, and the 
whole drawn over the little one's feet, then but- 
toned behind, and the process is complete. 

The advantages of the last method of dressing 
are — 

1. Perfect freedom to the organs contained with- 
in the chest, abdomen and pelvis. 

2. Suspension of the clothing from the shoulders. 

3. Saving of time to the mother and fatigue to 
the infant in the process of dressing. 

4. A uniform covering of the whole body. 

So much for the day clothing. At night the 
dress should consist of the flannel and the outer 
garment. 

In the foregoing, my intention has been to lay 
special stress upon the advantage of holding the 
garments in place by tape or buttons rather than by 
pins, and it should be noticed that a baby may be 
completely dressed with but one pin in its clothing, 
namely, that fastening the napkin. This, which is 
allowed only for the sake of convenience, must be 
a safety-pin, the ordinary pointed pin being an 
abomination in the nursery. 

It is hardly necessary to say that, for the sake 
of cleanliness, an abundant supply of body clothing 
should be at hand; a mother, particularly, must 
ici ognize that "cleanliness is next to godliness," 
and provide accordingly. Let her remember, too, 



»4 HYGIENE OF THE NURSERY 

that fresh clothing must be thoroughly aired or 
dried before it is put upon the infant. 

Sometimes, to keep the body clothes dry, a piece 
of thin rubber cloth is placed over the napkin; this 
does nothing but harm, for it overheats the parts, 
and when the diaper is wet with urine, makes a 
poultice of it, and thus macerates the skin and 
causes irritating and painful excoriation. 

At the age of six months in summer and of eight 
months in winter, provided, in both cases, the health 
be good, the clothing may be shortened. This 
change introduces several important questions, 
namely, the covering of the legs and knees, and the 
selection of shoes and stockings. 

The shortening process makes no change in the 
body clothing except that the skirts end a short dis- 
tance below the knees, at about the point to which 
an ordinary shoe top comes; this, of course, prac- 
tically leaves the legs, from the top of a short stock- 
ing to the lower edge of the napkin, exposed. As 
already hinted, it is necessary for the health of the 
infant to keep this comparatively large surface pro- 
tected, except, perhaps, during a few extremely 
hot days in midsummer. There are two ways of 
accomplishing this : either by drawers or by stockings 
long enough to extend from the feet to the nap- 
kin, to which they may be attached by safety- 
pins or ordinary fasteners. The best drawers are 



CLOTHING 85 

those made in two pieces, one for each leg, as 
shown in Fig. 12. 

These, as furnished in the stores, are made of 
merino, but any clever woman should be able to 
cut them out of Canton flannel and make them at 
home. They must fit the legs moderately closely, 
and have a buttonhole at the top, so that when 




passed over the napkin they may be buttoned to 
the waist of the skirt on its inner side, and so be 
held up. These drawers are not readily soiled as 
they cover the legs only, and the napkin comes be- 
tween. They must, of course, be made of material 
to suit the season — heavy in winter, light in summer. 
When stockings alone are used they must be 
long enough to come well above the knees, and 
should be held in position by "supporters" instead 



86 HYGIENE OF THE NURSERY 

of garters, since the latter, being necessarily tight, 
bind the limbs, and often, by interfering with free 
circulation, cause cold feet. The supporter must 
be adjusted to make only the required amount of 
traction, and this always in a direction parallel with 
the axis of the body. The stocking foot ought to 
fit easily, but without wrinkling, and at the same 
time have a roomy and rounded rather than a con- 
ical-shaped toe. For although the silk, woolen, or 
cotton material of which the stocking is composed 
may be yielding, it is elastic, and consequently 
capable of exerting a certain amount of pressure 
upon the foot; and there is little doubt that the per- 
sistent compression made by a short, sharply conical 
point cramps the toes, crowds them together, and 
sometimes even forces them to overlap one another. 

Colored stockings are often preferred to white, 
but they are only permissible provided the coloring 
matter be well fixed in the texture and not of such 
a nature as to cause irritation of the skin. Every 
stocking should be turned inside out, carefully 
examined, and all knots and ends removed, the 
smallest of which hurt the tender little feet, and 
stockings having seams to be pressed by the shoe 
into the back, soles or sides of the foot must be 
avoided. Were these details oftener looked to, 
many an unexplained tear would be avoided. 

As with the drawers, so with the hose; several 



CLOTHING * 87 

weights should be provided to correspond with the 
varying demands of the season for greater or less 
warmth, and in both cases a sufficient supply must 
be kept to allow of frequent changing. 

The shoes are prominent items of the clothing; 
their shape, size and manner of fastening, and the 
make-up of the soles being the important matters 
for consideration. 

An infant's feet are plumper than those of the 
adult, and all the tissues, but especially the bones, 
are softer. They may be readily deformed by 
protracted pressure from badly constructed shoes, 
despite the assertions of unhandy shoemakers, who 
say that the feet are shapeless masses of fat, for 
which any leathern bag having the semblance of a 
shoe will serve as a covering. 

Throwing out the element of fleshiness, the 
characteristics of the perfectly formed baby and 
adult foot do not materially differ. In the first 
place, the inner and outer margins are very different 
in contour; second, the heel and middle third of 
the foot is firm and presents little mobility in its 
( omponent bones, whereas the anterior third, in- 
cluding the toes, is very mobile. The toes again 
bear much the same relation to the rest of the foot 
as the fingers to the hand. This is particularly 
noticeable in the great toe, which, instead of inclin- 
ing toward a line passing along the center of the 



88 HYGIENE OF THE NURSERY 

foot, points away from it, in the same manner as the 
thumb from the hand, although, of course, to a far 
less degree. An inclination of the great toe toward 
the mid-line of the foot is undoubtedly often seen in 
adults, but in them it is a deformity resulting from 
badly-made shoes, and one that gives a conical 
contour to the toes, cripples the movements of the 
great toe, and greatly interferes with the ease of 
walking, just as a contraction and permanent draw- 
ing of the thumb toward the palm of the hand 
would materially lessen the usefulness of that 
member. 

The normal position of the toes just described 
will be readily understood from the tracing of the 
sole of the foot as shown in Fig. 13. 

The most striking features of this diagram are, 
the expanded position of the toes; the width of the 
anterior part of the foot compared with the heel, 
and the straight outer and curved inner margins of 
the foot. The line AB represents the axis of 
walking, which, while nearly parallel to EF, the 
inner edge of the foot, forms quite an angle with 
CD, the center line. 

In the normal foot the great toe is directly in the 
axis of walking, a position in which, of course, it 
is of much greater service than if it were inclined 
inward toward the line CD. 

Now, if a line be drawn closely around the mar- 



CLOTHING 89 

gin of the imprint, it will give the exact shape of 
a perfect shoe sole for the right foot; or taking the 
imprint of both feet, we get the outlines shown 
in Fig. 14. 

B D 

F- : 




C A 
Fig. 13. — Tracing of Normal Foot. 

On first sight, one would suppose that a shoe 
with a sole so shaped would look very awkward, 
but when made by a skilful shoemaker, it differs 
very little in appearance from those ordinarily sold 
in the shop, with the exception that it is broader at 
the toes. 



90 HYGIENE OF THE NURSERY 

Another important fact is clearly demonstrated 
by Fig. 14, namely, the absolute necessity of having 
the shoes made "right" and "left," and the fallacy 
of supposing that one or the other shoe may be used 
on either foot indiscriminately. 

Besides having a correct shape, the shoes 




Left Foot. Right Foot. 

Fig. 14. — Shape of Proper Shoe Soles. 



should be long enough not to cramp the toes and 
bend them down and backward upon themselves. 
At the same time it is a mistake to have them too 
long, allowing the foot to slide back and forth, as 
this leads to the formation of either blisters or 
corns. Let the shoe fit snugly about the heel and 
instep, and easily at the toes, and all is well. I say 



CLOTHING 91 

easily at the toes, because many an otherwise good 
shoe is ruined by having the uppers at the points 
too scanty, so that the toes are forced against the 
sole and subjected to painful pressure. 

The best method of fastening is by a lace, since 
this admits of making one part of the upper tight 
and another part loose, according to circumstances. 

Elastic fastenings, as in so-called congress shoes, 
are not good for children; and when buttons are 
used, the nurse must not necessarily leave them in 
the position fixed by the shoemaker, but move one 
or more as the size of the ankle demands. 

The thickness of the soles depends upon the age 
of the child. Before walking is attempted, they 
may be thin, flexible, and of uniform thickness from 
heel to toe; afterward they should be made heavier 
and more resisting, in order to protect the tender 
feet, and should be decidedly thicker at the heel, 
that this part of the foot may be elevated. A clear- 
cut heel, however, as in boots adapted for adults, 
is not to be recommended in children's shoes before 
the age of six or eight years. 

Sometimes a careful mother may notice that, for 
a short time after stockings and shoes are put upon 
her baby, the feet are cooler than before. Undue 
pressure about the ankle, with consequent inter- 
ference with the blood circulation in the feet, is the 
cause of this, and the remedy is to remove occa- 



92 HYGIENE OF THE NURSERY 

sionally the coverings, chafe the feet into warmth, 
and see that the shoe-top is not so tightly laced or 
buttoned as to constrict the ankle. 

So far, all that has been said of the clothing 
after shortening refers to the day and house gar- 
ments. It remains now to consider the night dress 
and the extra wraps to be worn out of doors. 

At bedtime, all the clothing worn during the day 
being removed, the baby is washed, and after the 
application of a fresh napkin and binder, is ready 
for the night dress. This consists of a shirt and 
a special gown. The shirt should be of flannel 
or merino, a light gauze in summer and a heavier 
material in winter; its pattern may be the same as 
that worn by day, though its texture ought to be a 
trifle lighter. The best pattern of a winter night- 
gown is a long, plain slip, with a drawing string at the 
bottom, to prevent exposure of the feet and limbs, 
should the child kick off the bed covering during 
sleep. It ought to be made of flannel, or the more 
easily washed Canton flannel. In summer, a loose 
muslin slip of the same design, but without the 
drawing string, may be worn. There is even more 
temptation by night than by day to use a rubber 
cloth over the napkin, to protect the body and bed 
clothing, but never do this. 

It is a good plan to provide the child with a flannel 
garment corresponding to the dressing gown of the 



CLOTHING 93 

adult, and with a pair of bedroom shoes. The 
latter are composed of soft leather or felt soles and 
knitted uppers, and are fastened around the ankle 
by a soft elastic. Both of these will be found use- 
ful in the many occasions when the child has to be 
taken up at night. 

When dressing a child for exercise in the open 
air in cold weather, do not put on the extra outer 
clothing until immediately before leaving the house, 
and remove it directly on returning. A long cloak, 
with or without capes, according to the degree of 
cold, and a pair of long, warm leggings, constitute 
the extra covering for the body. Protect the head, 
in winter, by a close-fitting thick cap; the hands, 
by worsted gloves or mittens. 

In summer the child may go out of doors in the 
same dress worn in the house, the head being pro- 
tected from the direct rays of the sun by a broad- 
brimmed, light straw hat. 

Every mother must decide for herself when her 
child is to doff the costume of babyhood and assume 
that of the boy or girl. There are two points that 
must always be considered, however, namely, the 
time of dispensing with the napkin and with the 
abdominal belt. Abandon the napkin, and sub- 
stitute ordinary drawers, as soon as the child can 
be trusted to make known the calls of nature — a 
period that varies considerably with the care and 



94 HYGIENE OF THE NURSERY 

skill in training. The binder, as already indicated, 
should always be worn until about the end of the 
second year. 

In clothing the boy or girl, be particular to se- 
cure warmth, freedom of movement and cleanliness. 
The first is accomplished by enveloping the whole 
body — no matter what the season — in woolen 
underclothing. This means high-neck and long- 
sleeve flannel shirts and flannel drawers extending 
down to the ankles. It is hardly necessary to men- 
tion that the thickness of these garments must vary 
with the seasons, but it is quite worth while insisting 
upon woolen undergarments, except during the 
very excessively hot days of midsummer. This 
provision being made, and the shape of the shoes 
and stockings* looked into, it matters little what 
may be the fancy of the mother in regard to outer 
clothing. While securing warmth, we must not go 
to the other extreme and burden the child with 
underwear so heavy that constant perspiration is 
produced. The risk of this is great during the winter 
in the, so often, over-heated city house, and it is 
much better to select underclothing of just sufficient 

* It is impossible for either a stocking or shoe to fit accurately 
unless the toe-nails be kept in good order. In cutting the toe-nails 
there is, as in every other affair of life, a right and a wrong way. 
Cut the nail directly across, without rounding the corners. Should 
the latter be done, the nail is apt to grow into the flesh and give 
suffering to the child and work to the surgeon. 



CLOTHING 95 

weight to keep the skin warm without over-activity, 
depending upon thick overcoats and wraps to 
conserve the body temperature when out-of-doors. 
Again it must be remembered that there are a few 
children who cannot comfortably wear woolen un- 
derclothing on account of a very sensitive or a very 
active skin. These either suffer from irritation 
rashes or, having a constantly moist surface, are 
readily chilled in passing from warm rooms to a 
cool outdoor air, and do much better when clothed 
with some other material, as linen-mesh or cotton 
stockinet. 

Freedom of movement refers not only to the 
limbs, but to the chest and abdomen, which should 
never be constricted, lest the important organs they 
contain be crippled in their action. Loose-fitting 
clothes accomplish this object; but it is to be under- 
stood that looseness or ease in fit does not necessarily 
imply that the dress must be awkward, ill-fitting, 
and a source of mortification to the wearer. On 
the contrary, clothes must be easy and yet well cut 
and stylish. 

To be clean, the child must have a plentiful sup- 
ply of clothing, so that changes may be made as 
frequently as required. Clean, cheap clothes look 
much better than soiled finery. 

The night dress or a child five or six years old 
consists, during winter, of a light, high-neck and 



96 HYGIENE OF THE NURSERY 

long-sleeve merino shirt and night drawers of Can- 
ton flannel; in summer, of a gauze undershirt, with 
short sleeves and muslin night drawers. 

Cold weather calls for a warm overcoat, hat, 
mittens, and leggings, or rubber boots in wet or 
snowy weather, when the child leaves the warmth 
of the house. Should the cold be so great as to 
necessitate ear tabs and a neck wrap for protection, 
a child under six years is better off in the nursery. 

As to rainproof clothing — and our climate calls 
often for both rubber boots and a long mackintosh — 
it must be remembered that such coverings, while 
impervious to moisture from without, are no more 
pervious to body moisture or, in other words, to 
perspiration, which secretion they encourage by 
their warmth. Of course, when perspiration is re- 
tained, the underclothing becomes moist, and there 
is a great risk of surface chilling and consequent 
catarrh. Therefore, it is a good plan, when water- 
proof garments have been worn for any length of 
time, to take off the underclothing as soon as shel- 
ter is reached, to rub the surface into a glow with a 
coarse towel and then redress the child. 

Before concluding this chapter, let me advise 
that the change from winter to spring or summer 
clothing be not made at any fixed date, under the 
supposition that it is the time to change, and the 
weather should be warm, whether it is or not. In 



CLOTHING 97 

our Eastern climate it is unusual to have settled, 
warm weather until June. May has a certain num- 
ber of warm days, but they are quickly followed 
by cooler ones. Consequently the safe plan is to 
keep on the winter flannels until hot weather 
surely sets in, changing, in the meanwhile, the 
outer clothing to suit each day. 



CHAPTER V. 

EXERCISE AND AMUSEMENTS. 

Healthful exercise, especially when taken in the 
open air and sunshine, invigorates the nerves; se- 
cures an active performance of such vital functions 
as circulation, respiration and digestion; maintains 
a hearty appetite and regular movement of the 
bowels, and develops the muscles. 

Symmetry of development is essential, and on 
this account any exercise or play that brings but one 
or a few sets of muscles into action must be dis- 
countenanced. The muscles control the bones, and 
should one set be comparatively feeble, the bones 
they move are dragged out of form by stronger 
opposing sets. Probably the most important groups 
of muscles to render strong are those of the back 
which hold the spine in proper position. When 
these are weak — the greatest weight of the trunk 
being toward the front — the backbone has a ten- 
dency to be drawn forward in such a way that the 
movements of the chest are crippled, and respira- 
tion so interfered with that the blood is imperfectly 
aerated, nutrition fails, and the child becomes a 
weak, puny invalid. 

98 



EXERCISE AND AMUSEMENTS 99 

Curvature of the spine — the deformity here re- 
ferred to — may also interfere with other functions; 
for instance, digestion, elimination of urine and 
the motion of the legs. Bone deformities are more 
apt to occur in children than in adults, because, in 
the former, the bones, not being thoroughly set 
and hardened, are more readily influenced by irregu- 
lar muscular action. 

Marking, then, the necessity for equal muscular 
development, the subject of exercise may be taken 
up in detail. 

The first exercise the infant gets will be in the 
nurse's arms. Shortly (three or four days) after 
birth the baby may be taken from its crib two or 
three times a day, and, being placed upon its back 
on a pillow, carried about the room for ten or fifteen 
minutes. In the second month, longer walks may 
be taken, the pillow being discarded and the infant 
carried in a reclining position in the arms, with the 
head and body thoroughly supported. 

By the fourth month the child will have gained 
sufficient muscular strength to maintain a sitting 
posture for a short time, provided the head and 
shoulders be supported by the nurse's hand, and in 
this way it may be carried about on the right or 
left arm — and it is most important not to use one 
arm constantly — for its daily training. 

At the end of the eighth month a healthy child 



IOO HYGIENE OF THE NURSERY 

ceases to require support to the head and back 
when carried, but not before. 

After the infant ceases to be merely a sleeping 
and eating animal, and begins to show signs of 
humanity — at about the fourth month, for ex- 
ample — he should be laid upon a soft mattress or 
sofa several times each day and allowed to do as he 
pleases. 

Under these circumstances he rolls about and 
kicks his legs, clasps and unclasps his fists, moves 
his arms, and crows or cries. All these movements 
serve a purpose; the legs gain strength for future 
walking; the hands, for grasping; the arms, for 
carrying, and the vocal organs^ for speaking. 

A certain class of nurses seems unable to com- 
prehend that a baby is a tender creature, tender 
not only in age, but in the texture of all its tissues. 
They support a young infant upright upon their 
knees and violently jolt it up and down, under the 
supposition that it gives pleasure, and should the 
child cry they add to its torment by a peculiar 
"song." Gentle movement is as pleasant to the 
child as riding in an easily running carriage on a 
smooth road is to an adult; knee-jolting is as un- 
pleasant and harmful as a journey over the worst 
corduroy road. The so-called singing must cause 
only pain. 

The question of "airing" or subjecting the infant 



EXERCISE AND AMUSEMENTS IOI 

to out-door air, arises soon after birth. Airing 
in-doors consists in taking the child fully dressed as 
if going out, into a room having a southerly ex- 
posure, with wide open windows but closed doors 
to prevent a strong current of air. It may be begun, 
even in winter, at the age of one month, the first 
airing lasting for fifteen minutes only, and the time 
slowly increased, by ten minutes daily, until three 
or four hours are occupied. This procedure is safe 
and beneficial in practically all sorts of weather, 
and with delicate children and those recovering from 
an illness, should be the only form of airing allowed 
during the winter months. 

Airing out-of-doors should be commenced, under 
normal conditions, as soon as the child has arrived 
at the proper age, and providing always that the 
weather be favorable. The fifth month is the proper 
age for children born in the early fall and winter, 
and the second month, for those born in summer. 
In cool weather they should be taken out in a 
baby carriage or in the nurse's arms, for an hour 
in the morning and half an hour in the afternoon, 
while the sun is shining. In summer, they may pass 
the greater part of their waking hours in the open 
air. In damp and rainy weather, when there is a 
strong east or north wind blowing, or when the 
mercury stands below 20 F., young children are 
better off in the nursery. The hardening process, in 



102 HYGIENE OF THE NURSERY 

our climate, so far from being successful, usually 
results in an attack of bronchitis or something 
worse, which may house the child for a long time, 
and thus deprive him of the advantage of sub- 
sequent favorable weather. 

How shall the baby be taken out? The answer 
to this question involves the consideration of two 
points, namely, the clothing and the means of con- 
veyance. The former has already been refer r ed to. 

As to the method of conveyance, the arm is to 
be preferred for very young infants, especially in 
cold weather, because they are apt to be uncomfort- 
able in a baby carriage, and because as they must, 
when carried, be held close to the nurse's body, 
they are kept warm by the heat given off from the 
bearer. 

After the fourth month a carriage may be used. 
Now there are good and bad baby carriages, as well 
as a right and a wrong way of trundling them; and 
here again the mother must not forget that the baby 
is a tender creature and very easily hurt. 

The best kind of carriage is none too good for 
the load it is destined to carry. It should run 
smoothly, without jolt or jar; its wheels should be 
provided with rubber tires and kept from creaking 
by the frequent application of some mineral oil, 
as sewing-machine oil; the bed must be soft and 
comfortable, lateral support being given to the body 



EXERCISE AND AMUSEMENTS 103 

by two long, narrow and soft pillows; the infant 
must never be strapped down, the feet must be kept 
properly covered and warm, and the parasol 
always must be at hand, and so arranged as to 
protect from wind, and shade the tender eyes from 
bright sunlight. 

While the carriage is a convenience to the nurse, 
it is never to be regarded as a place of security for 
the child, to be left on the sidewalk or in windy 
places while the wheeler exchanges gossip with 
fellow-nurses or enters a house to visit friends. 
However good its springs may be, they are never 
easy enough to allow of rude jolting or of mount- 
ing a raised curbstone by mere dint of hammering 
and muscle force. 

After the age of nine or ten months a healthy 
child will begin to creep; at the end of a year he 
will make efforts to stand, and from four to eight 
months later will be able to walk by himself. Chil- 
dren, however, present great differences in this 
respect, and a delay of a few months must not be 
considered abnormal. Second children are usually 
more active than those born first, since they imitate 
and are encouraged by the example of their elders. 

As soon as efforts at creeping are made there 
need be no fear that insufficient exercise will be 
taken; the care should be, rather, to prevent over- 
fatigue, as the baby, delighted by its new-found 



104 HYGIENE OF THE NURSERY 

powers, will be inclined to exert them all day 
long. 

The question arises at this stage whether or not 
the nursery floor is a permissible field for exercise. 
This depends entirely upon the child's health, the 
state of the weather and the condition of the nursery. 
Remember always that the stratum of air next to the 
floor is much lower in temperature than the middle 
or upper. In some of the biting days of winter it 
becomes so cold as to make the feet and legs of an 
adult uncomfortable, and completely to chill a child, 
who, in creeping, has his whole body in it for long 
periods. Therefore, should a child be delicate, 
should he have either bronchitis or catarrh of the 
digestive tract, should the weather be very cold, or 
should the heating of the chamber be imperfect, it 
is better to keep him off the floor and let him take 
his exercises on the nurse's bed, which may be 
stripped down to the mattress for the purpose. 
Colds are contracted and many more are protracted 
by playing on the floor in winter. 

Many nurses, and some mothers, have an idea 
that a child should walk at a certain fixed age, and 
when this time arrives, put into practice various 
plans for teaching the process. Beware of this, for 
go-carts, leading-strings, baby- jumpers and all con- 
trivances of this ilk have a tendency to flatten the 
chest, distort the spine, or deform the legs. The 



EXERCISE AND AMUSEMENTS 105 

proper and only safe plan is to let the child teach 
himself to walk. This he readily does, first through 
the act of creeping, in which he exercises every 
muscle of the body without throwing undue weight 
upon the soft bones. When by this exercise he has 
sufficiently strengthened the muscles, he will in- 
stinctively seek to do more; first in an effort to get 
upon the feet, in which, though failure occurs over 
and over again, he perseveres until successful in 
standing with support, then without, and finally ends 
in walking. 

The first acquisition of the power of walking 
should not be overtaxed, and for a month or more 
the carriage is the best means of airing; but as soon 
as sufficient strength is acquired for active exercise — ■ 
a somewhat variable age — the child should walk out 
and pass as much time as the weather and nursery 
requirements permit in the open air. Set walks, 
however, are an abomination to the child as well as 
to the adult. City-bred children suffer in this 
respect, as they are too frequently sent out merely to 
walk a certain number of blocks, or for a fixed 
time, and it is no wonder that they quickly tire of 
such exercise and prefer their nurseries to the streets. 
The only way to avoid this is to give an object to 
the outing, as, for example, a household errand or 
the purchase of a cheap toy. In the country, on 
the other hand, children run about and amuse 



106 HYGIENE OF THE NURSERY 

themselves according to their own pleasure, visit 
the garden or the farm, and involuntarily take that 
kind and degree of exercise best calculated to 
promote the growth and development of their 
bodies. 

Delicate children preeminently require pure air 
and an outdoor life, although many of them are too 
feeble to take sufficient exercise on foot. For such, 
when the parents' purse allows, a donkey or a pony 
should be provided. Driving may give sufficient 
exercise at first; but as soon as enough strength is 
gained, riding is to be preferred, as it keeps the 
mind more healthfully occupied, strengthens the 
muscles, expands the chest and produces a healthy 
appetite and digestion. Children who are not 
allowed sufficient out-door life because they take 
cold easily, should live in cool rooms, wear less 
heavy underclothing to insure a dry skin, and have 
the body, particularly the chest and back, sponged 
once daily with cool water — 5o°-6o° F. — or, in 
the case of young infants, 65°-7o° F. 

In the earlier years of life the girl and boy play 
together and take nearly the same sort and amount 
of exercise. As time goes on, however, and the 
girl approaches nearer and nearer to maidenhood, 
she too frequently begins to look upon her brother's 
game of ball or romping play as too rough, and 
spends a constantly increasing time indoors acquir- 



EXERCISE AND AMUSEMENTS 107 

ing the manners and the sedentary habits of her 
elders of the same sex. 

This tendency is often encouraged by parents, 
who prefer polished manners to physical strength, 
and, above all, dislike their daughters becoming 
"torn-boys." One must admit that polished man- 
ners are a great attraction; but as a woman has 
more important duties than shining in a drawing- 
room, they are of little intrinsic value when uncom- 
bined with the fine carriage and good figure which 
belong to robust health. 

In regard to the carriage and figure, it is useless 
to try to assist their formation by the aid of braces 
and stiff corsets. The latter are especially to be con- 
demned. Unless most cautiously used, they induce 
undue contraction of the lower part of the chest 
and displace the solid organs (liver especially) of 
the abdomen, interfering primarily with respiration 
and digestion, and secondarily with the general 
processes of nutrition. An erect carriage can be 
better secured by attention to the general health; 
suitable diet; regulation of the bowels; cold bath- 
ing and sponging, and exercise short of fatigue, not 
of particular muscles only, but of the whole frame. 
My advice, therefore, is to let the girls join in the 
boys' play, liy this plan the latter gain, because 
they are naturally forced to be more gentle, and the 
former, because their rapidly-developing frames get 



108 HYGIENE OF THE NURSERY 

the requisite amount of exercise. It is well, how- 
ever, to curb the ambition of the girls to equal the 
athletic powers of the boys, for their muscular 
strength is less. Without letting the subjects know, 
keep a strict lookout upon the general morals, for 
it is absurd to shut one's eyes to this risk in mingling 
the sexes in later childhood and youth. 

Amusements. — A child's life must be devoted to 
the cultivation of his mind and his body, an undue 
development of either resulting in an incomplete 
manhood or womanhood. 

After writing the above sentence I was called 
from my desk to the bedside of a little sufferer, and 
on my way met two boys, both about nine years of 
age, and both patients of mine. The first had a 
spirituelle face, and spoke to me with a tip of the 
hat and the grace of a little Chesterfield; but his 
features were pinched, so it seemed to me, while 
his face was anxious and his legs were hardly thick 
enough to carry his body. Nevertheless, his arms 
were full of books, which, as I had curiosity enough 
to examine, I found to be a Greek grammar, Csesar, 
and the elements of algebra. I felt sorry for the 
overtaxed little brain, and he showed no symptoms 
of joy at release from school, for he was on his way 
home to study all his books, to get the teacher's 
approval and a high mark on the morrow. Scarcely 
a block away I met my next little friend; his cheeks 



EXERCISE AND AMUSEMENTS I09 

were rosy, his arms and legs sturdy, and his eyes 
brimful of health and fun. The burden of books 
he bore was light, and his teacher probably con- 
sidered him stupid; but his simple "Hello, Doctor, 
I am off for a game of ball this afternoon," and his 
jolly smile were more pleasing than all the learning 
of the first little gentleman. 

The lesson taught by these two children is very 
plain to my mind, and the question which will 
come out ahead in the long run is easily answered; 
for health has no handicap in the race of life. 

It is right, of course, to let the children study — 
after the sixth year; but the brain is not to be cul- 
tivated at the expense of the body. In other words, 
our boys and girls must have plenty of play. 

The subject of childish diversion is a broad one, 
and it is only possible to outline it here. Let the 
healthy child play as much as possible in the open 
air, and let him be as active as he pleases; for his 
own sensations will tell him when to stop and when 
to begin again. The only cautions are not to over- 
look him too much; to let him make as much noise 
as he wishes out of doors and in his own kingdom 
— the nursery; to make him play those games 
which will exercise all the muscles of the body 
equally, and to guard him, when heated, from drink- 
ing ice-water or from lying on the cold, damp 
ground, or sitting in a draught. It must be remem- 



IIO HYGIENE OF THE NURSERY 

bered, also, that play is the child's business, so that 
during convalescence from a debilitating disease it 
must be regulated according to the strength. 

Before closing this chapter a protest must be 
entered against roller-skates, as they are dangerous 
to life and limb. Bicycles with wheels of equal 
size are not objectionable, if the proper upright 
position on the seat be insisted upon and if the 
temptation to too long and too fast riding be 
resisted. 



CHAPER VI. 



For some time after birth infants spend the inter- 
vals between being fed, washed and dressed, in 
sleep, and thus pass eighteen or twenty out of the 
twenty-four hours. As age advances, the amount 
of sleep required becomes less, until at two years 
fourteen hours, and at three years twelve hours, are 
enough. The amount of sleep required will, how- 
ever, vary condiserably in different children, but an 
observant mother can soon determine this question 
for herself. 

Any marked diminution in the average duration 
of sleep, or any decided restlessness indicate dis- 
ease, and demand attention from the physician. At 
the same time, sleep, perhaps more than any other 
item of nursery regimen, is a matter of training, 
and many a mother, by want of judicious firmness, 
has rendered the early yeais of her child's life not 
only a burden to himself, but an annoyance to the 
entire household. 

One cannot too soon begin to form the good habit 
of regularity in sleeping hours, and so far as circum- 
stances admit, the following rules may be enforced: 



112 HYGIENE OF THE NURSERY 

Fiom the second week to the end of the sixth or 
eighth month the infant must sleep from 10 p. m. to 
6 a.m., and as many hours during the day as nature 
demands and the exigencies of the nursery permit. 
This does not mean that the baby is not to be put 
to bed until nearly midnight; on the contrary, he 
should practically settle for the night at six o'clock, 
but the last feeding should be at ten o'clock. After 
this he must rest undisturbed with the exception, 
sometimes, of one night feeding, during the first six 
months, until the early morning hour, when he 
should be fed and sleep again. During the day, 

6 A. m. to 6 p. m., the baby should be trained to 
sleep between feedings, being promptly roused 
when the regular hour arrives. 

From eight months to the end of two and a half 
years, a morning nap should be taken, say from 12 
to 1.30 or 2 p. m., the child being undressed and 
put to bed. Occasionally an afternoon nap for half 
an hour or more seems necessary, although, as a rule, 
sleep at night is more undisturbed and refreshing 
if this be omitted. The night's rest must begin at 

7 p. m. If a late meal be required, the child can be 
taken up at about ten o'clock, but if past the age 
for this, he may sleep undisturbed until he wakes 
of his own accord, sometime between 6 and 8 A. M. 
As soon as thoroughly awake the child must be 
taken up, washed and dressed, and given breakfast. 



SLEEP 113 

This is the only way to cultivate the habit of early 
rising, which promotes both bodily and mental wel- 
fare, and of all habits is the most conducive to a 
long and healthy life. 

By early rising it is not meant that the child shall 
be roused from a sound sleep by a rough voice or 
hand at a certain fixed hour in winter and an ear- 
lier one in the summer, simply for the whim of a fad- 
ridden and overprompt parent. Quite the reverse. 
Let the child wake of his own accord, for he will do 
so — whether it be late or early — after he has had 
enough sleep; and, if he must get up at a certain 
hour — and never fix it before 7 A. m. — make the 
rousing process as gentle and gradual as possible. 
Sudden rousing excites the brain, quickens the pul- 
sation of the heart, and, if repeated, may lead to 
serious consequences. 

From two and a half to four years, an hour's 
sleep may or may not be taken in the morning, 
according to the disposition and needs of the sub- 
ject, but a child should invariably be put to bed at 
seven in the evening and not be permitted to rise 
until six or seven o'clock on the following morn- 
ing. 

After the fourth or fifth years, few children will 
deep in the daytime; they are ready for bed by 8 
i'. m., and must be allowed to sleep for ten hours or 
more. 

8 



114 HYGIENE OF THE NURSERY 

A later retiring hour than 9 p. m. ought never to 
be encouraged until after the twelfth or fifteenth 
year. Any postponement of the usual hour for 
going to bed is injurious, and should abridgment 
of sleep be accompanied by the excitement of a 
child's party, or the like, the rest obtained is broken 
and productive of a pale face and nerveless frame 
on the succeeding day. 

The position and general features of the night 
nursery have already been described, and it only 
remains to say that when occupied by day it must 
be darkened so as to favor sound sleeping. 

The bed (and where there are several children 
in the family each should have its own) must be 
so situated in the room as to be out of the way of 
draughts. Curtains, while they protect, prevent 
the access of fresh air, and it is far better to ward 
off a draught by a movable, folding screen. 

The form of bed known as a crib may be occupied 
until the sixth year. The sides must be high, to 
prevent the child from falling out and injuring 
himself, and the movable side should work upon 
hinges or move up and down in slots. 

Springs and a soft horsehair mattress, protected 
by a gum cloth, placed beneath a double sheet, 
under ordinary circumstances constitute the bed 
proper. Sometimes a feather mattress is admissi- 
ble, but this is only when the child is feeble, and 



SLEEP 115 

requires artificial aid to keep up the normal body- 
heat during sleep. 

The objection to feathers is, that the body, sink- 
ing deeply in, is so completely enveloped that it is 
subjected to an undue degree of heat, which relaxes 
and weakens the system and renders it very sus- 
ceptible to the injurious influences of cold. 

The bed covering is composed of a sheet, one or 
more blankets — according to the weather — and a 
spread. These must be warm enough to maintain 
a healthy temperature, but, at the same time, not 
so heavy as to oppress the child. 

Special care should be taken not to cover the 
nose or mouth, and it is much better to keep the 
air of the nursery at a proper, even temperature by 
an open fire than to secure warmth to the body 
alone by weighty bed coverings. 

A pillow ought not to be used with young infants, 
later it must be small and thin, and made of soft 
horsehair. 

The bed should never be made up directly upon 
the child's leaving it, for then it is saturated with the 
DO) lurnal exhalations from the body. When va- 
ra ted, the bed coverings must be thrown over the 
backs of (hairs, the mattress shaken up, and, the 
windows of the chamber being thrown open, allowed 
to air for an hour or more. 

In tin- matter of bed clothing, cleanliness is as 



Il6 HYGIENE OF THE NURSERY 

important as in body clothing, and the nurse must 
never neglect to remake a bed if the sheets become 
wet with urine or otherwise soiled, no matter at 
what hour of the night the accident may occur. 
Much trouble in this direction may be avoided, 
however, by regularly taking up the child at the 
time of the last feeding and encouraging a through 
evacuation of the bladder. 

Children should never sleep in the same room 
with persons who are ill, whether the disease be 
acute or chronic. Sleeping with those having a 
long-standing cough or consumption of the lungs 
is especially to be avoided. Do not get the baby 
into the habit of being rocked or walked to sleep, 
and do not allow older children to sleep too soon 
after a meal, as the processes of digestion are apt 
to produce restlessness and uneasiness. Again, a 
bright light or loud conversation in the bedroom 
should never be permitted after the children have 
settled to rest; but they should be taught to sleep 
through any ordinary noise, as the sound of foot- 
steps or low talking. 

Finally, teach the nurse to make up the bed 
neatly and smoothly, and direct her to turn the pil- 
low and smooth out the sheets, should her charge 
be restless at night. By this latter procedure sound 
sleep is often brought to a fretful child. 

Sleeping out-of-doors, in suitable weather, is 



SLEEP 117 

very health giving. In summer, between 7 a. m. 
and 7 P. m. an infant of one month may sleep in the 
open air in its coach placed in a sheltered position. 
In winter, between 9 a. m. and 4 p. m., when the sun 
is shining and the mercury above 32 F., a baby 
four months old, being well wrapped up, may sleep 
in its carriage on a porch or some other protected 
place. 



CHAPTER VII. 

BATHING. 

A well-known English writer states that ''water 
to the body— to the whole body— is a necessity of 
life, of health, and of happiness; it wards off dis- 
ease, it braces the nerves, it hardens the frame, it is 
the finest tonic in the world." 

On the word "tonic" the whole subject hinges. 
Every one knows that food, even in such a simple 
form as milk, may be given to excess, with the pro- 
duction of illness, and that medicines are yet more 
easily abused. Why, then, if the bath be a ionic 
agent, may it not be often used injudiciously and 
to the detriment of the child? 

Intelligent nurses, who have grown gray in ser- 
vice, often say they have seen babies "washed into 
heaven." This act has never been actually accom- 
plished in my experience, but it has been often 
enough approached to justify introducing this chap- 
ter with the caution that, should the infant be ailing, 
the bath had better be discontinued until the phy- 
sician can be consulted. This, of course, does not 
preclude ordinary cleanliness, for every part of the 
118 



BATHING 119 

child's body liable to become soiled can be readily 
cleaned by the use of a moist sponge, with or with- 
out soap, and without bringing into play any of 
the medicinal or, in other words, tonic effects of 
the bath. 

The initial bath differs from those that succeed 
it during infancy in the fact that it involves a special 
procedure, namely, the removal of the vernix caseosa, 
a tenacious, white paste-like material, which usually 
adheres to the skin of the new-born. This should 
be removed as soon after birth as the nurse, having 
made the mother comfortable, can turn her atten- 
tion to the child, and this process consists in first 
rubbing the whole surface gently, though thor- 
oughly, with a bit of soft flannel covered with white 
vaseline or fresh lard, and next wiping off the 
softened, greasy coating with a dry piece of absorb- 
ent cotton, or a very soft towel; especial care being 
taken to thoroughly clean the arm-pits, and the 
creases back of the ears and in the groins and 
buttocks. A dry, sterile dressing is then applied to 
the cord; a flannel binder adjusted; the face washed 
with warm water and a soft wash cloth 01 absoibent 
cotton; the baby enveloped in a warmed blanket, 
laid in its crib, on its right side, in a quiet and 
darkened room, and allowed to sleep for six 
hours. 

After this preliminary cleansing, one bath a day 



120 HYGIENE OF THE NURSERY 

should be the rule until the completion of the third 
year of life. 

For the first ten days the infant must be bathed 
on the lap, or "sponged," a full tub-bath never 
being given until the cord has fallen off and the 
navel healed. For the first bath the water should 
have a thermometer measured temperature of 
ioo° F., the same water must not be used in washing 
the body, and the face and head, or the reverse, 
and in giving the bath the abdominal binder is 
neither to be removed nor allowed to become wet. 
The nurse, seated on a low chair with her gown 
protected with an upper flannel and an under rubber 
apron, should take the infant, naked with the excep- 
tion of the binder and wrapped in a warmed blanket, 
upon her lap and proceed in the following way: 
Wash the face and head with warm water — no soap 
— and a wash cloth and carefully dry. Clean the 
eyes by squeezing a solution of boric acid (one 
teaspoonful to four ounces of water) from a thor- 
oughly saturated bit of absorbent cotton into the 
inner corner of each eye letting it run under the lids, 
the infant being placed on its back and the head 
turned to the right for the right and the left for the 
left eye; the cotton must be held quite close, a new 
piece used for each eye, and after the douching 
the wet cotton is passed over the eyes so as to 
gently wipe them. The infant being still on its 



BATHING 121 

back, clear the nose with a little alboline dropped 
from a medicine dropper into each nostril, this 
causes sneezing with the expulsion of the softened 
nasal mucus. Wash the mouth with a small swab 
of absorbent cotton wet with normal saline solution, 
passing it gently over the whole surface, including 
the tongue, gums, cheeks and roof of the mouth; 
the nurse's ringer must never be used. Clean the 
ears, so far as possible without penetrating the 
auditory canal, with warm, unsoaped water and a 
soft wash cloth. Next bathe the body with castile 
soap and warm water applied by a wash cloth, 
being careful not to wet the binder, then wash 
away the soap with a sponge, and, finally, pat the 
surface dry with a very soft towel. With girl babies, 
clean the external genitals, each day, with absorbent 
cotton saturated with boric acid solution. With 
boys, the foreskin must be retracted every other 
day and the parts gently bathed to remove all 
secretions. 

The daily full tub-bath is, as already stated, 
begun after the navel has healed, and is in some 
of its details similar to "sponging." This bath 
must be given by the monthly nurse so long as 
she remains in attendance; afterward the mother is 
the proper person, unless the nurse-maid be excep- 
tionally careful and experienced; and even in this 
event the mother should superintend the process. 



122 HYGIENE OF THE NURSERY 

A tub with a supply of water, a piece of soft 
flannel for a wash-rag, absorbent cotton, a fine 
sponge, a bit of good soap and several soft towels 
are the necessary articles. A long apron made of 
soft flannel is also useful, and it is well to provide a 
low chair and a piece of oilcloth to place on the 
floor underneath the tub. The former enables the 
bather to get more on a level with her work and 




Fig. 15. — Bath Table, 
t, elastic tapes for steadying tub. 



make a deeper lap for the child to rest in, and the 
latter receives any water that may be splashed about. 
A stand is now made to hold the baby's bathtub, 
Fig. 15, and is so contrived that it can be folded up 
and laid away when not in use. It is convenient, 
inasmuch as it obviates the necessity of stooping 
over, by bringing the child more on a level with the 
bather. It has straps and hooks attached to the 
sides to hold the tub firmly in place while in use. 

An ordinary oblong tin tub, painted white inside 
and large enough to give plenty of room, is to be 



BATHING 123 

preferred to either a porcelain basin or a wooden 
tub. When in use, the tub should be placed on the 
floor, for the sake of firm support, or on the bath 
table, and afterward must be well cleaned, dried 
and aired. 

Water for the bath ought to be pure and soft, and 
should it be muddy or otherwise foul, the nurse 
must take the trouble to filter it. The character of 
softness is an important one, and when it is impos- 
sible to obtain anything but hard water from the 
ordinary sources of supply, a special provision 
ought to be made for the collection of rain water. 
The quantity used at a time should be sufficient to 
cover the child up to the neck when placed in the 
tub in a semi-reclining position. 

A matter of great importance is the temperature 
of the water. Some — fortunately very few — people 
use cold water from the first, under the impression 
that it is strengthening. So far from this being the 
case, cold water, instead of hardening, depresses 
the vital forces and frequently produces inflamma- 
tion of the eyes, nasal catarrh, and inflammation of 
the lungs and bowels. 

While cold baths are not to be recommended, 
one must not go to the other extreme, and use too 
hot water; for this also weakens the frame and 
renders it more susceptible to the attacks of disease. 

The initial temperature of ioo° F. must be 



124 



HYGIENE OF THE NURSERY 




maintained in subsequent baths until the child is 
three or four months old, and then 
slowly reduced, so that by the end of 
the sixth month it is 95 and through- 
out the second year from 85 to 90 , 
being somewhat lower in summer 
than in winter. As the heat of water 
cannot be estimated by hand with any 
degree of accuracy, it is essential to 
use a bath thermometer (Fig. 16). 

Place this instrument in the water 
and allow it to remain a few moments, 
so as to get a full effect upon the 
mercury. Should the water be too 
hot, it may be readily cooled by the 
addition of cold water, or, if too low 
in temperature, is easily raised to the 
proper degree by pouring in hot water. 

It is impossible to insist too strongly 
upon the necessity of uniformly using 
the bath thermometer. Several times 
in my experience a tin bathtub has 
been filled with water so hot that its 
sides burned the delicate skin of the 
little hand placed upon it. Fortu- 
nately, in such instances, the conse- 
quent screams led to careful investi- 
gation, and no serious damage resulted. On the 



Fig. 16. — Bath 
Thermometer. 



BATHING 125 

other hand, I have felt the water cold enough to 
pain the fingers. Don't neglect the thermometer, 
then! 

A piece of flannel is very useful for the first part 
of the bathing. It readily takes soap, and, being 
soft, can be thoroughly rubbed over the skin with- 
out danger of injury. A large, soft sponge, how- 
ever, is best suited to the finishing of the bath, for 
it 'holds more water than a flannel wash-rag, and 
enables the bather to stream the water over the 
child's body, and thus get the stimulating effect of 
a miniature shower bath at the same time that 
the dirt and superfluous soap are washed away 
from the surface. The wash-rag and sponge must, 
by the way, be the child's exclusive property, and 
are not to be used twice in succession without being 
thoroughly cleaned and dried in the open air. 

Unscented Castile or glycerin soaps are the 
best to use. Common soaps are irritating to the 
skin, and even the purest and most bland articles 
must be employed with care, that is, neither too 
frequently not too profusely, lest they lead to ec- 
zema or other cutaneous disorders. When any skin 
disease is present, the physician's advice must be 
had not only as to the use of soap, but also in refer- 
ent e to the propriety of the bath itself. 

Two towels are required for each bath. These 
should be large and composed of fine, soft material. 



126 HYGIENE OF THE NURSERY 

They must be dry and warm, and perfectly clean 
before they are applied to the surface of the 
child. 

The bath apron should be made of two pieces of 
soft, white flannel; one long enough to extend from 
the waist almost to the feet of the bather, and broad 
enough to completely cover the front of her gown; 
the other quite as broad but about four inches 
shorter. Both pieces are sewed to a waist belt, 
forming, in reality, two aprons; the upper of which 
is thrown over the shoulder when the infant is being 
lifted from the tub, and then used as a dry and 
warm covering when he reaches the lap. After the 
bath, the apron, being more or less wet, must be 
taken off and thoroughly dried. Several such arti- 
cles should be provided, as they must be frequently 
washed to keep then clean and free from odors. 

Any low chair will do to use in bathing, although 
as those usually sold have not a sufficiently broad 
seat to give a comfortable support, it is better to 
make one by sawing off the legs of an ordinary 
wooden kitchen chair. 

The bath must be given at a regular time each 
day. The best hours are in the morning, midway 
between two feedings, and in the evening, just 
before the infant gets his last feeding and goes to 
bed. The first is perhaps the better hour, but 
regularity is the more important point. 



BATHING 127 

At the time selected, place the tub containing the 
water, heated to a proper temperature, in a warm 
and sheltered part of the room, and around it ar- 
range, within convenient reach of the hand, the 
various requisites of the bath. 

Upon undressing the child, wet his head first; 
then let the head and shoulders rest on the left 
forearm and lower the child gently into the water, 
that his body may be covered as far as his neck. 
Take a wetted and soaped flannel wash-rag in the 
right hand and pass it rapidly but thoroughly over 
the body, avoiding the eyes. Pay particular at- 
tention to the arm-pits, to the region between the 
folds of the buttocks and to the groins. This done, 
take a large, well-filled sponge in the right hand and 
squeeze the contents over the body. The chief 
force of this miniature douche must fall upon the 
back and loins, and the child, during the operation, 
must be lifted clear of the bath-water by the left arm 
and hand. 

The sponge is used simply to clear off the dirt 
loosened by the wash-rag, and to remove all super- 
fluous soap; therefore, when this is accomplished, 
the child shouM be lifted from the tub to the lap 
and enveloped in a towel, or, better still, in the 
loose folds of the bath-apron. The drying process 
now begins and consists in absorbing the moisture 
from the skin. This is done by a series of very 



128 HYGIENE OF THE NURSERY 

gentle patting movements with a towel folded over 
the palm of the hand. In drying a baby, special 
attention must be given to those portions of the 
body where the natural folds form crevices in which 
water may lodge. Unless these parts be thoroughly 
dried, serious consequences may ensue. If it be 
retained in a normal crevice — the fold of the but- 
tocks or behind the ears — it causes in a short time 
troublesome excoriation. 

" Never allow anything smaller than the elbow to 
enter the ear" is excellent advice; although during 
the bath should water get in and be allowed to re- 
main it may lead to earache and abscesses, and 
in extreme, though not rare, cases, to deafness. 
In the event of this a blunt cone formed out of a 
soft handkerchief or of absorbent cotton will quickly 
absorb the moisture, and will do no harm if inserted 
but a very short distance within the orifice. 

The nose can readily be cleaned by dropping 
alboline into the nostrils, or by the very careful 
use of a small cotton swab, especially if a little 
vaseline be added to facilitate the process. The 
mouth must be washed in the way already described, 
with a swab of absorbent cotton, and this is to be 
done only twice daily, not before or after each 
feeding. The male and female genitals must 
receive the same attention as in "sponging," but 
in regard to the former, after the first year it is 



BATHING 129 

quite sufficient to retract the foreskin and wash the 
parts, once or at most twice a week. 

After the infant ispatted perfectly dry — not rudely 
rubbed with a towel — the whole surface, but es- 
pecially the region on either side of the spine, should 
be rubbed with the naked palm until the skin be- 
comes slightly red. This modified massage ends the 
bath, and the child must then be dressed as quickly 
as possible. 

Several important points yet remain to be men- 
tioned. Never give a bath immediately after a 
meal nor when the child is either cold or overheated. 
Never suddenly or rudely plunge the body into the 
water; never allow the time of actual immersion 
to exceed five minutes, and during the first three 
months limit it to two minutes. Under no circum- 
stances should the head and face be allowed to dip 
beneath the surface. Should this happen, the child 
will become so frightened that it will be difficult 
to get him to enter the water again. And here, by 
the way, it may be well to state that if there be repug- 
nance to the bath, the tub may be covered over with 
a blanket, and the child, being placed upon it, may 
be slowly lowered into the water without seeing 
anything to excite his fears. 

While the infant's head should be wet before each 
bath, it must not be washed every day. Too fre- 
quent cleaning and the too frequent use of soap dry 

9 



130 HYGIENE OF THE NURSERY 

the skin and lead to seborrhoea or other cutaneous 
disorders; once a week is quite often enough to 
wash the scalp. The buttocks and thighs require 
bathing after each bowel movement; this should be 
done with simple warm water and absorbent cotton, 
and after the parts are thoroughly cleansed they 
must be as carefully dried before adjusting a fresh 
napkin. 

The question of the propriety of using powder 
after a bath is often asked by mothers. Powdering 
has always seemed to me to be a lazy way of absorb- 
ing the moisture that should be taken up by a dry 
towel, and unless there be some excoriation or other 
indication for its use, the skin can be kept cleaner 
and healthier without it. In cases, too, in which 
some disorder of the skin would seem to warrant its 
employment, better and quicker results are ordi- 
narily obtained by the application of cold cream, 
oxide of zinc ointment, or vaseline. 

The rule of one bath a day may be exceeded in 
very hot weather, when, in addition to the morning 
full bath, the body may be sponged twice daily with 
water at a temperature of 85 to 90 F. This, con- 
trary to what might be expected, has a greater and 
more permanently cooling effect than bathing with 
cold water. 

From what has been written, one might suppose 
that the details of an infant's bath are endless. So 



BATHING 131 

they must seem when given in full. A skilful bather, 
however, ought to fulfil every requisite and com- 
plete the bath in a period of time not exceeding 
twenty minutes at the very outside, and this must 
include not only the actual five minutes' immersion, 
but the preparation of the bath and the drying 
process. 

The full bath should be omitted under the follow- 
ing conditions: in all cases of acute illness until 
the physician has seen the child; when there is 
eczema or other skin affection, and in feeble and 
delicate infants to avoid the risks of exposureand 
fatigue. 

After the third year three full baths a week are 
quite sufficient. An evening hour is now to be 
preferred, but the water must be heated to 90 F. 
in winter, though it may be cooler in the heat 
of summer. While, at this age, the child has his 
three full baths weekly, for the purpose of securing 
absolute cleanliness he must be sponged every day 
with water, cool or warmed to the season. 

The sponge bath is best given in the morning, 
soon after the child has roused himself from sleep 
and before any food is given. The nurse, for this, 
must provide herself with a large basin containing 
water at a temperature of 75 in summer and 85 
in winter, a large, fine sponge and several towels. 
The bath-apron being <lonned and the child's night- 



132 HYGIENE OF THE NURSERY 

clothes removed, the sponge filled with water is 
passed rapidly over the whole surface of the body; 
then the child must be wrapped up in the apron 
and the skin first dried gently with a soft towel and 
then rubbed into redness with the open hand. 
When this process is completed — and it should be 
done in at least ten minutes — the clothing is put on 
rapidly, and the child is ready and usually hungry 
for his morning meal. No soap need be used in 
these baths. 

In the tri-weekly cleansing bath the process of 
washing is much the same as in infancy. That is, 
the bathtub being filled with water at a temperature 
of about 90 , the child is put into it up to his neck 
and thoroughly soaped with a wash-rag, and next 
douched clean with a large sponge. Here, also, 
the head must be wet first; the body immersion 
must not last longer than five minutes, and the dry- 
ing must be done quickly and with a patting rather 
than a rubbing movement. Ample reaction of the 
skin must be secured by gently rubbing with the 
palm of the hand, especially over the spine. 

The washing of the head is a most important 
matter, as it cleanses the scalp, prevents the for- 
mation of scurf, and adds beauty to the hair. At 
the same time the nurse must be careful how she 
dries the hair. To rub it gently with a soft towel 
and then brush it out with a fine hair brush is the 



BATHING 133 

proper plan. Combing, in so far as it means dress- 
ing the hair and cleansing the scalp with a fine 
comb, must never be allowed, as it not only thins 
the hair by pulling it out by the roots, but also 
irritates the scalp and produces eruptions upon it. 

As the child approaches puberty he must gradu- 
ally be taught to wash himself, and should be en- 
couraged to form the habit of bathing every day. 
The bath at this age should be a sponging rather 
than a soaking process; it is best taken in the morn- 
ing directly after rising, and the temperature of the 
water may range from 65 to 75 , though delicate 
children may require it warmer, especially during 
winter weather. 

When childhood merges into youth, while the 
sponge is still preferable to the plunge, water may 
be used, all the year round, just as it flows from the 
faucet. The temperature will be, of course, quite 
low at times, but so long as the bath is taken in a 
warm room, completed quickly, and followed by a 
sense of stimulation and warmth, nothing but good 
results. 

Whatever room be used for the purpose of the 
toilet, the child, if he be old enough to bathe him- 
self, should occupy it alone, so that the whole body 
may be stripped naked; otherwise washing cannot 
be thoroughly or effectually accomplished. 

A boy should wash his head each morning; a 



134 HYGIENE OF THE NURSERY 

girl, who has long hair, at least once a week. Any 
loitering over the bath is attended with the danger 
of chilling. Never occupy more time than fifteen 
minutes in the whole process. 

These daily sponge baths are ordinarily quite 
sufficient to keep the person perfectly clean. Some- 
times, however, it is necessary to take, in addition, 
a full warm bath at intervals of a week. These 
baths are relaxing if too prolonged; ten minutes is 
the maximum time for remaining in the water. 
After leaving the tub there must be no exposure to 
draughts. The best hour for such a bath is in the 
evening; some time after the last meal and just 
before going to bed. 

Sea-water baths are useful for a child of any age, 
although ordinary sea bathing is not to be recom- 
mended until the child is old enough and strong 
enough to hold his own in a moderate surf — after 
the eighth year, for instance. A younger subject 
may, when at the seaside, be dressed daily in a 
bathing suit and allowed to splash for a time at the 
edge of the surf. The process of carrying a child 
against his will into the waves and immersing his 
head, as is often done, is cruel and productive of 
so much terror that more harm than good results. 

In our climate, the proper season for sea bathing 
is from the middle of June until the middle of 
September. 



BATHING 135 

On arriving at the coast, it is always well to pre- 
pare for the plunge in the sea by giving, on the 
first day, a warm salt-water bath. On the day 
following, about three hours after breakfast, the 
child may don his bathing dress. Immediately on 
entering the water, the head must be thoroughly 
wetted. After this, the bath may be protracted for 
fifteen, or at most twenty, minutes. To get the 
invigorating effects of a surf bath, it should never 
be repeated oftener than once a day, and in some 
cases it is better to allow a day to intervene, or even 
to enter the water only twice a week. Drying and 
dressing should be rapidly performed, and a half- 
hour's brisk walk is very useful in promoting re- 
action and causing free circulation of the blood. 
Should the bather feel faint after coming out of the 
water, he must be wrapped in towels and given half 
a tumblerful of milk containing one or more tea- 
spoonfuls of brandy or whisky, and the succeeding 
baths should be at longer intervals and for shorter 
periods, or the) must be discontinued if their effect 
is uniformly depressant, and a daily sponge bath 
of equal quantities of salt and fresh water substi- 
tuted. When the child is either cold or perspiring 
freely, the bath must not be undertaken. 

The bathing suit should be of light flannel, made 
in one piece like a pair of moderately loose night 
drawers, but with short arms and legs; it should 



136 HYGIENE OF THE NURSERY 

open only over the shoulders, where, when put on, 
it is fastened by buttons. This arrangement permits 
of easy removal after the bath when the flannel is 
saturated with sea water, and is, in consequence, 
heavy and sticky. 

The question of sea bathing suggests that of 
swimming. Boys, and girls too, should early 
learn to swim. The art is not only a safeguard, but 
a means of most pleasant and invigorating exercise. 
It develops the muscles, expands the chest, aids 
digestion, strengthens the whole frame, and pro- 
motes energy, courage and self-reliance. 

Swimming, like every other exercise, must be 
taken in moderation. Even with this care it is not 
always beneficial. The bather should leave the 
water experiencing a pleasant glow over the whole 
surface of the body; the spirits and appetite should 
be increased, and there ought to be a sensation of 
augmented strength. If, on the contrary, it should 
disagree, there is a sense of chilliness, with lassi- 
tude and depression of spirits; the face is pinched 
and pale, and the lips and finger-nails are apt to 
look blue. 

Swimming in salt water is more invigorating 
than in fresh. Apart from the different quality of 
the two waters, the battling with the waves in the 
former case is more exhilarating, and the sea breezes, 
blowing upon the body, carry with them health 



BATHING 137 

and strength. Every one must have noticed the 
increased softness and beauty of the skin and the 
greater lustre of the hair after a sojourn at the sea- 
side. 

It may be serviceable next briefly to detail the 
different baths in common use as well as those most 
often directed by physicians, with some reference to 
their effects upon the system. 

Concerning temperature, the bath may be: — 

1. Cold, temperature 50 to 65 F. 

2. Cool, temperature 65 to 75 F. 

3. Temperate, temperature 75 to 85 F. 

4. Tepid, temperature 85 to 92 F. 

5. Warm, temperature 92 to 9S F. 

6. Hot, temperature 9S to 112 F. 

When giving a cold bath, strip the child in a warm 
room, and rub him thoroughly with the palm of the 
hand until the whole body, especially the spinal 
region, is warm. Let him then stand in a tub con- 
taining enough hot water to cover the feet, and 
sponge him rapidly with cold water. The tempera- 
ture of the latter must never be below 50 F., and 
65 is usually cold enough. The addition of half 
an ounce of rock salt or a tablespoonful of concen- 
trated sea water to the gallon, renders it more stimu- 
lating and insures a complete reaction. After 
sponging, the surface must be thoroughly and 
quickly dried with a soft towel and rubbed with 
the open hand until aglow. 



I38 HYGIENE OF THE NURSERY 

This bath, provided the degree of cold does not 
exceed the resisting powers of the child, is a power- 
ful tonic, producing rapid tissue changes and in- 
creasing nutrition. Should the water be too cold, 
or the sponging continued too long, reaction does 
not follow the primary shock, and the result is fa- 
tigue, exhaustion, or even dangerous prostration. 
This bath, therefore, must be used with caution and 
only under a physician's advice. The cases in which 
it is of most service are those in which there is a 
sluggish circulation with poor appetite and feeble 
digestion; in which the nutrition is impaired, 
as in rickets, and in certain spasmodic nervous 
disorders. 

A cooled bath is sometimes prescribed, and may 
be employed with advantage in conditions attended 
with very high fever. The child is first immersed 
in water at 95 , and this is gradually lowered to 70 
by the addition of cold water, the process occupy- 
ing from fifteen to thirty minutes. 

Analogous to this bath is the cold pack. Fold a 
sheet in such a way as to be long enough to extend 
from the child's arm-pit to his feet, and wide enough 
to encircle completely his body; dip it in water at 
90 and lay it smoothly upon a cot, the mattress of 
which must be protected by a rubber mackintosh. 
When all is in readiness, place the child upon the 
sheet, and wrap it around his body and legs. A 



BATHING 139 

blanket must then be thrown over the sheet and the 
pack left undisturbed for ten minutes. Then lift 
the child out quickly and envelop him in a warm 
blanket and allow him to remain at rest for some 
little time. 

In the absence of the physician, sponging with 
water at a temperature of 85 to 95 is the only 
safe bath to employ to reduce temperature. In 
giving this bath, strip the child and place him in 
bed between blankets, while the nurse, inserting her 
hand between, must pass a damp sponge slowly 
over the surface. Five to ten minutes may be con- 
sumed in this operation, although if the child com- 
plain of chilliness, discontinue the sponging at once; 
a sensation of cold, too, indicates the use of warmer 
water. The operation may be repeated several 
times daily, or as often as every two hours in urgent 
cases, and when the heat reduction is of short 
duration. 

The hot bath, 98 to 112 , is employed for vari- 
ous purposes — to relieve nervous irritability, to 
promote sleep, to produce sweating, and to draw 
the blood to the surface in the event of congestion 
of some internal organ. Whether a full bath or 
merely a foot bath be required, five minutes is suf- 
ficient time for immersion; then, with or without 
drying, according to the degree of sweating desired, 
the whole body, or only the feet and legs in case 



I40 HYGIENE OF THE NURSERY 

of a foot bath, must be enveloped in a blanket, and 
the child put to bed. To render these baths more 
stimulating, a teaspoonful to a tablespoonful of mus- 
tard flour may be added, and the child held in the 
water until the arms of the nurse begin to tingle. 
The hot bath is purely stimulating, and it is impor- 
tant not to continue it too long, lest the primary and 
only desirable effect be followed by depression. 

The blanket bath is useful in producing perspira- 
tion. Wring a blanket out of hot water and wrap 
it around the child: then throw three or four dry 
blankets over him and leave him for half an hour. 
Rub the body then with a soft towel to absorb the 
moisture thoroughly, and keep the child in bed. 

There are several medicated baths in frequent 
domestic use, which it may be useful to describe. 

Mustard Bath. — Take from two teaspoonfuls to 
two tablespoonfuls of mustard flour; hot water, two 
to four gallons. 

In the form of a foot bath it produces sweating and 
determines the blood to the surface. As a general 
bath it acts as a powerful stimulant. 

Salt-water Bath.— Take four tablespoonfuls of 
rock salt, or Ditman's sea salt, or concentrated sea 
water; water, warm or cool, according to season, 
four gallons. 

To be used as a general bath every morning in 
chronic tuberculosis, scrofula, rickets, and general 



BATHING 141 

debility. Bath to be followed by thorough rubbing 
of the surface, especially over the spine. 

Bran Bath. — Take one pint of bran; tie up in a 
muslin bag, place in a quart of water, boil for an 
hour, squeeze bag thoroughly into the water, and 
add to four gallons of warm water. 

Useful in eczema and other skin diseases. 

Soda Bath. — Take one tablespoonful of bicar- 
bonate of sodium; warm water, four gallons. 

Used in skin affections. 

Hot air or Vapor Bath. — The body-clothing 
being removed the child is laid upon a bed, the bed- 
clothing is pinned tightly about the neck so that the 
head only is outside, and raised about a foot above 
the body by an arrangement of hoops or a wicker 
support. Hot air or vapor is then introduced be- 
neath the raised bed-covering from a croup-kettle. 
This bath causes free perspiration in from ten to 
twenty minutes, and may be continued for twenty or 
thirty minutes unless faintness or giddiness be pro- 
duced, when it should be stopped at once. Such 
baths are especially useful in case of suppression of 
the urine, and in uremia. 

Disinfectant Bath.* — Take six and one-half 
ounces of liquid carbolic acid (90%), four ounces 
of glycerin, and four gallons of warm water (98 
F.) ; or six ounces of solution of chlorinated soda and 

*See Chapter XI. 



142 HYGIENE OF THE NURSERY 

six quarts of warm water. Applicable for disinfec- 
tion of the person after an attack of scarlatina or 
other contagious disease. Neither of these solutions 
is as efficient as bichloride of mercury in the pro- 
portion of i to 5000, but this is such a poisonous 
substance that it should never be used without a 
physician's oversight. 

Compresses are often useful. The wet compress 
consists simply of a roll of flannel or soft linen 
dipped in cold or hot water, according to circum- 
stances, and wrung out and then applied to the part 
indicated. Cover this with a piece of oiled silk 
rather larger than the compress. 

There are several matters that bear a more or 
less close relation to the subject of bathing. These 
are the care of the teeth, nails and hair. 

The teeth must be cleaned morning and evening, 
and the cleaning process must be begun with the 
appearance of the first tooth. Ordinarily, a soft 
wash rag folded over the forefinger, or swab of 
absorbent cotton dipped in cool water and thor- 
oughly rubbed over the teeth, is sufficient to keep 
the early teeth clean, and does not injure the tender 
gums. Should a dark-colored scum form at the 
junction of the tooth and gum, a little prepared 
chalk or other bland tooth powder may be used in 
addition. If it be impossible to get at the point of 
discoloration in this way, shape with a penknife a 



BATHING 143 

moderately hard bit of wood into the form shown 
in Fig. 17, then rub the woody fibres at the ex- 
treme end into a sort of brush, wet this, dip it in 
the toothpowder and gently rub at the discolor- 
ation until it disappears, taking care not to make 
the gum bleed. Over a piece of wood so shaped 
one may also wrap a bit of soft 
cambric and use water and powder 
as before. 

Take good care of the milk teeth, 
for if they become decayed and 
broken off or lost, their permanent 
substitutes are apt to come in ir- 
regularly and produce a lasting 

, . . Fig. 17— Stick for 

deformity. Cleaning Teeth. 

The tooth brush can be used 
after a number of the milk teeth have been cut. 
The bristles should be very soft and fine, and it 
must be employed with gentleness. Unless there 
should be some discoloration, no powder need be 
used. The child should early learn to clean his 
own teeth. 

The importance of taking care of the toe-nails 
has already been referred to in the chapter on cloth- 
ing. The finger-nails should not be allowed to 
grow too long; at the same time it is a bad plan 
to cut them close to the quick. In trimming them, 
Use a moderately dull pair of scissors, and do not 



144 HYGIENE OF THE NURSERY 

round them too much. When hang-nails appear, 
they must be cut close with sharp scissors. The 
fingers and toes should be inspected carefully after 
each bath, to see if they require attention. 

Directions have already been given in regard to 
washing the hair. All that remains to be said now 
is to repeat the caution against the use of a fine 
comb, and to protest against the employment of 
hair oil and hair washes. The best scent for the 
hair is an occasional dressing of soap and water; 
the best beautifier is a thorough brushing with 
good brushes, and the latter should be employed 
every morning and evening. 

. Besides keeping the long hair of a girl free from 
scent and grease, do not dress it over the ears or tie 
it up tight and make it "like a cap of iron over the 
skull." 

If the hair be well brushed and the scalp thus 
sufficiently stimulated, there will be enough natural 
oil secreted to keep it tidy; artificial oily applications 
only act temporarily, and by blocking up the pores 
of the skin tend to make the hair drier and harder 
to keep in order. 

Should there be a tendency for the hair to fall 
out, wash the scalp thoroughly and frequently 
with soap and water, and stimulate it by firm 
brushing and the use of a wash such as the follow- 
ing: 



BATHING 145 

Take of— 

Aromatic spirit of ammonia 1 fluidounce. 

Tincture of cantharides 1 J fluidrachms. 

Glycerin \ fluidounce. 

Rose water 7 fluidounces. Mix. 

A tablespoonful of this may be rubbed into the 
scalp once every day, the rubbing to be followed by 
washing with a sponge and vigorous brushing. 

In such cases, however, it is best to seek the 
advice of a physician, for falling out of the hair may 
be due to a variety of causes. 



CHAPTER VIII. 

FOOD. 

The choice of food and the method of feeding 
bear so close a relation to age that it is necessary, 
in studying these questions, to regard them from 
the stand-point of the two stages of a child's life 
mentioned in the first chapter; that is to say, the 
periods of infancy and childhood. 

Infancy. — An infant may be fed in one of three 
ways: i, from the mother's breast; 2, from the 
breast of a foster-mother or wet-nurse; and, 3, 
from a bottle, by the method known as artificial or 
hand-feeding. 

1. Feeding from the maternal breast. — There can 
be no doubt that this, being the natural, is at the 
same time the proper method of nourishing the 
human infant; and fortunate is the baby that, in 
our day of advanced civilization and city living, 
can draw from the breast of a robust mother an 
abundant supply of pure, health-giving, tissue-build- 
ing food. 

It follows, therefore, that every woman who is 
free from certain contraindicating diseases, to be 
146 



FOOD 147 

mentioned later, should nourish her child solely 
from her breast up to the age of eight months, and 
partially to the end of the first year, or, failing in 
either limit, as long as possible. 

The infant should be put to the breast as soon as 
the mother has recovered somewhat from the fatigue 
of labor — some four or eight hours after birth. Of 
course no milk can be drawn at this early date, but 
the baby gets a small quantity of thin, watery fluid, 
called colostrum, which affords sufficient nourish- 
ment, and at the same time, from its laxative prop- 
erties, clears away the greenish or black viscid 
material that collects in the infant's intestinal canal 
during intra-uterine life. This procedure, too, is of 
great advantage to the mother, for it insures proper 
contraction of the womb, draws out the nipples, and 
encourages the formation of milk. 

As the secretion of milk is never fully established 
until the third day after labor, it stands to reason 
that no food other than the colostrum is required 
before that time. Hence, the practice of filling the 
infant's stomach with gruel, sugar and water, and 
other sweetened mixtures, is more than useless, for 
it diminishes the activity of sucking and the conse- 
quent stimulation of milk production. Put the 
child to the breast every two hours while the mother 
is awake, and there need be no fear of starvation. 

After the third day, should the breast not yield 



148 HYGIENE OF THE NURSERY 

a supply of milk, a mixture of cream, two teaspoon- 
fuls, whey and water each three teaspoonfuls, and 
one-fourth of a teaspoonful of sugar of milk, may 
be given every fourth hour, the baby being put 
to the breast in the meanwhile. When the flow 
begins, however, the artificial feeding is to be dis- 
continued. 

Usually on the fourth day milk is secreted and 
regular lactation commences. Many untrained 
mothers make a failure of nursing because they 
know nothing of the manner of giving suck; of the 
length of time the child should be kept at the breast; 
of the proper time for and interval between feed- 
ing, and the importance of regularity. Upon 
these points the physician should give minute in- 
structions. 

When giving the breast, the infant must be held 
partly on its side, on the right or left arm, accord- 
ing to the gland about to be drawn from, while the 
mother must bend her body forward, so that the 
nipple may fall easily into the child's mouth, and 
steady the breast with the first and second finger of 
the disengaged hand, placed above and below the 
nipple. In case the milk runs too freely — a condi- 
tion very apt to excite vomiting — the flow is easily 
regulated by gentle pressure with the supporting 
fingers. Each of the breasts should be drawn alter- 
nately, the contents of one being usually sufficient 



FOOD 149 

for a meal; and a healthy child may be allowed to 
nurse for fifteen minutes or until satisfied, when he 
will stop of his own accord, drop the nipple and fall 
asleep with milk still flowing over his lips. 

During the first six weeks the breast is required 
every second hour, from 6 a. m. until 10 p. m. At 
night the infant should be put in a crib by the 
mother's bed, or in an adjoining room, under the 
care of a competent nurse, and there remain quietly 
until the morning feeding. This secures the mother 
eight hours of uninterrupted repose, a matter of great 
importance to her general health and consequent 
capacity for prolonged lactation. As to the infant, 
he may rebel at first, and wake and cry, so that it is 
necessary to quiet him with a little milk and water 
administered from a bottle; but often, after a few 
days and certainly at the end of a week or two, the 
good custom of sleeping at night is formed, and 
there is no further trouble. 

Regularity in meal hours is even of more impor- 
tance in early than in adult life, on account of the 
natural feebleness of digestion, and, further, regular 
nursing has a marked influence upon the maternal 
food supply, for it is a fact that breasts which are 
emptied at fixed intervals produce more and better 
milk, than those called upon irregularly and too 
frequently. To secure regularity, it is only neces- 
sary to have a little perseverance, for infants are 



150 HYGIENE OF THE NURSERY 

such creatures of habit that a short training brings 
them into the way of expecting food only at cer- 
tain times, and, when healthy, they wake to suck 
the breast with almost the precision of the clock. 
While insisting upon this rule, one must recognize 
the fact that, although in the vast majority of 
instances a two-hours' interval is most suitable 
up to the second month, there is no absolute law as 
to the number of daily nursings. Some infants 
seem to need food less frequently, and it is best to 
respect their peculiarity and not force the breast 
upon them so long as they sleep well, do not fret 
when awake, and thrive generally. Others, again, 
may require it oftener, every hour and a half, per- 
haps, and once or twice at night. In these excep- 
tional cases an appropriate schedule can only be 
made by close observation of individual character- 
istics. 

A common and most ruinous mistake is to resort 
to constant feeding as a means of pacifying crying. 
Babies certainly do cry from hunger, but just as 
frequently the crying results from colic, or from the 
discomfort and pain of indigestion. Every mother 
should be able to recognize the difference. The cry 
from hunger usually begins after a sound sleep. It 
is not peevish, and stops at the sight of the breast, 
when the infant rouses himself, presents an expres- 
sion of pleasure, clinches his hands and flexes his 



FOOD 151 

limbs. The cry of colic is violent and paroxysmal; 
the face is livid and wears an expression of suffer- 
ing; the abdomen is distended and hard; the 
hands and feet are cold; the legs are drawn up or 
kicked violently about ; and an explosion of wind from 
the mouth or bowels ends the attack. A peevish 
cry, hot skin and sour breath attend indigestion. 

It stands without saying that the cry of hunger 
must be relieved by giving food; but this is the 
very worst thing to do under other circumstances, 
for it both breaks up good habits and produces 
serious mischief. The pain of colic and the discom- 
fort of indigestion are chiefly due to the accumula- 
tion of flatus resulting from the fermentation of 
food. Mothers soon learn, and unfortunately 
infants too, that the breast milk temporarily relieves 
suffering. This it does in the same way as any other 
warm liquid; but, unlike a simple fluid, milk only 
adds more material to the already fermenting con- 
tents of the gastro-intestinal canal, and every nurs- 
ing is soon followed by more pain, until between cry- 
ing and sucking and sucking and crying, the infant's 
life is passed in misery, if not cut short altogether. 
Instead of continuous feeding, the plan for relief is 
to decrease the quantity of food by increasing the 
intervals between nursing and by abridging the time 
of lying at the breast. 

After the sixth week the interval between nurs- 



152 HYGIENE OF THE NURSERY 

ings may be slowly increased until, by the fourth 
month, it reaches three hours. During this period, 
also, the time of lying at the breast jnay be gradu- 
ally lengthened to twenty minutes, for the quantity 
of milk secreted and the child's appetite and capacity 
for food are all augmented as the days pass by. At 
the end of the sixth month, feeding every fourth 
hour suits some children well, but as a rule the 
three-hour interval must be adhered to from the 
fourth month to the end of lactation. 

Many authorities recommend additional artificial 
feeding, alternating with nursing, after the sixth or 
eighth month. This plan of mixed feeding is 
perfectly proper, if the baby ceases to gain strength 
and flesh while on the breast. If otherwise, the 
maxim of not interfering with any course that is 
doing well is as applicable here as elsewhere, and 
the breast may be relied upon entirely until the 
time comes for weaning. Should additional nutri- 
ment be required, the food must be selected with 
due reference to age and prepared in the same 
manner as in regular bottle-feeding, and employed 
only to supplement the breast milk, which must be 
conserved as long as possible, since even a little 
natural food is of great value in insuring proper 
growth and development during the earlier months 
of life. 

It is a good plan, however, even when breast- 



FOOD 153 

feeding is progressing satisfactorily to begin, about 
the fifth month, to substitute one nursing daily by a 
bottle; this allows the mother more freedom for 
rest and recreation, and, at the same time, accus- 
toms the infant to being artificially fed, and in- 
creases the ease of weaning when this becomes 
necessary. Another means of facilitating the 
substitution of the bottle for the breast is to begin 
early to use it in giving the drinking water, which 
every baby requires three or four times daily. 

The date of weaning cannot be fixed for all cases, 
since it must depend upon two conditions — the 
health of the mother and the development of the 
child. When the former continues to be robust 
and the child steadily grows and gains flesh, lacta- 
tion can be prolonged until the tenth month. 
Usually if persevered in longer, the mother's 
strength begins to fail, her milk is lessened in 
quantity or becomes poor in quality, the child's 
nutrition suffers, and he grows pale, thin and flabby, 
and may develop the disease known as rickets. Not- 
withstanding the age, the beginning of summer is a 
bad time to wean an infant, and unless the indi- 
cations for withdrawing the breast are very urgent, 
it is better to postpone the change until the hot 
months have passed, resorting, in the meantime, to 
artificial feeding as a supplement to any deficiency 
in the maternal supply. 



154 HYGIENE OF THE NURSERY 

Change in the manner of feeding may be accom- 
plished gradually or suddenly. In gradual wean- 
ing, about four weeks are required to prepare for 
the absolute withdrawal of the breast. For instance, 
if suck be given every three hours, or six times a 
day, there should be, during the first week of prepa- 
ration, one artificial feeding and five nursings daily; 
during the second, two and four; during the third, 
four and two; during the fourth, five and one. 
Then the breast must be entirely withheld. Care- 
fully prepared milk-food, administered from a 
bottle, is the best substitute. At the age of ten 
months a mixture that ordinarily agrees well is: 

Bf. Cream i tablespoonful (fid. oz. £). 

Milk 8 tablespoonfuls (fid. oz. 4 ). 

Sugar of milk 1 teaspoonf ul. 

Water 3 tablespoonfuls (fid. oz. ij). 

This is to be poured into a perfectly clean bottle, 
warmed in a water-bath, and taken through a clean, 
plain rubber tip. Should the quantity (six fluid- 
ounces*) be insufficient to satisfy the child's appe- 
tite, the milk and water may be increased until the 
mixture measures eight fluidounces. 

When such accidents as fever or disordered diges- 
tion, with vomiting and diarrhoea, occur during the 
period of preparation, the number of artificial 

* One fluidounce=two tablespoonfuls. 
Onefluidrachm = one teaspoonf ul. 



FOOD I 55 

feedings must be reduced, or the breast resumed 
until the disturbance be passed; then the course 
may be begun again and carried to its completion. 

Usually there is little trouble in weaning infants 
in this way. Sometimes they become fretful under 
the change and may refuse food entirely for a day 
or more; but a little determination on the part of 
the mother and the cravings of hunger will soon 
overcome this difficulty. 

Occasionally the child refuses to suck milk from 
a bottle or to drink it from a cup or spoon — in fact 
seems to object to any form of liquid food except 
that drawn from the mother — while at the same 
time he is eager for bread or other solid food. 
Under these circumstances prepare for each meal a 
moderate portion of either rice pudding or junket. 
After these have been taken for a day or two, add 
to each meal a little milk, reducing the amount of 
pudding or junket; stir the whole together and 
feed from a spoon; next day still further reduce the 
solid and increase the liquid, and so proceed until 
finally a taste for milk is cultivated. 

Sudden weaning is not advisable unless, while 
the breast is being presented, there is an absolute 
refusal to take artificial food from either a bottle or 
a spoon. This is most apt to occur when food has 
been given too frequently, and when the breast has 
been used as a means to quiet crying. The plan is 



156 HYGIENE OF THE NURSERY 

also to be recommended when the mother's health 
becomes so affected as to render any further suck- 
ling a positive peril to the child's life; attacks of 
erysipelas or of small-pox are instances in point. 

The physician is often forced to decide upon the 
advisability of premature weaning. His decision 
must be made cautiously and after thorough in- 
vestigation of two propositions, namely: a, the 
effect of further lactation upon the health of the 
mother, and b, the requirements of the child. 

a. Lactation being a physiological process is not 
a drain upon the systemic strength so long as the 
functions of nutrition are actively performed, but 
under other circumstances it very frequently be- 
comes so. A mother- must make no attempt to 
nurse if she has tuberculosis, advanced cardiac or 
active kidney disease, hysteria, epilepsy, marked 
anaemia, cancer, goiter, or is septic or convulsed after 
child-birth. Premature weaning is necessary when 
the mother is attacked by a contagious disease or by 
any acute disease threatening dangerous temporary 
prostration, such as typhoid fever. Ordinarily, 
however, the general condition that leads to with- 
drawal of the breast is one of simple loss of strength 
and flesh on the part of the mother. Undoubtedly 
these indications often warrant the procedure, but 
every one who has seen much of children's practice 
must have met with many cases in which the advice 



FOOD 157 

to wean has been given carelessly and unnecessarily, 
and in which the child might have had its natural 
food had proper attention been given to the health 
of the mother. 

If a woman be worn out by household cares; if 
she wear herself out by a round of dinners, balls or 
shopping, or if she expose herself to injurious at- 
mospheric conditions and eat improper food, she 
grows weak and thin whether she be nursing or 
not; and a woman heedless of her health will prob- 
ably care little whether she suckles her child or 
gives it up to a wet-nurse or to the bottle. 

In addition to making nursing the important duty 
of her life for the time being, a mother must be as 
free from household cares as possible. Mental and 
physical fatigue must be avoided, sufficient exercise 
must be taken to maintain a healthy appetite and 
digestion, abundant time devoted to rest and sleep, 
and regular evacuations of the bowels secured. 
As to diet, the nursing mother requires a plentiful 
supply of fluids and of plain and easily digestible 
food, with a judicious portion of meat, vegetables, 
and fruit. She should eat three regular meals 
daily, with a cup of milk, cocoa or gruel at early 
bed-time, and in some cases between meals. She 
may be allowed eggs, plainly cooked; cereals and 
nearly all soups and vegetables; sweet fruits, and 
meat, usually once and never more than twice a 



158 HYGIENE OF THE NURSERY 

day; but must avoid acid fruits, salads, pastry and 
rich desserts; tea and coffee, except in extreme 
moderation, and wine or beer absolutely. 

Should the secretion of milk be scanty, it may 
often be increased by the free use of animal broths, 
chocolate, gruel, or milk, and sometimes the em- 
ployment of a good malt extract may be necessary. 
Such tonics as ferrated elixir of cinchona, bitter 
wine of iron, and the preparation known as "beef, 
wine and iron," are useful when there is anae- 
mia, or when the general failure of strength can- 
not be overcome by food and attention to hygienic 
rules. 

The ordinary local conditions indicating the 
necessity of premature weaning, on the mother's 
account, are fissures of the nipple, and mammary 
abscess. 

Fissure being usually a unilateral condition, it 
is only necessary to retire the affected side from 
duty and nourish the child alternately from the 
unaffected gland and from the bottle until healing 
takes place, the disabled breast being pumped or 
massaged in the meantime to keep up secretory 
activity. Should both sides be affected, weaning may 
be imperative, on account of the extreme pain pro- 
duced by sucking, although, even under these 
circumstances, an effort must be made to maintain 
the flow of milk by regular pumping. Sometimes 



FOOD 159 

women are able to struggle through the attack 
by taking advantage of the relief and protection 
afforded by a nipple-shield. 

Fissures of the nipple may be preceded by vari- 
ous diseases of the delicate skin of the part. They 
result, also, from want of cleanliness or from keep- 
ing the nipple too moist, and when constant sucking 
is allowed or when there is a continual flow of milk. 
They may be prevented by proper attention to 
the nipple before confinement. During the latter 
months of pregnancy the clothing covering the 
breast must be loose, and the wearing of a wire tea- 
strainer over the nipple to prevent pressure has 
been recommended by one authority. Each day, 
for three months before labor, the nipples should 
be washed thoroughly with hot water in the even- 
ing and anointed with cocoa-butter in the morn- 
ing. At the same time, should the nipples be 
small or retracted, the woman must be taught to 
use her thumb and finger to draw them out. This 
process is not only an advantage in giving proper 
size and shape, but brings the skin into good con- 
dition without hardening it. The application of 
alcoholic and astringent lotions is not to be recom- 
mended. They tend to harden the tissue, which 
should be soft and pliable rather than tanned, and 
render the nipples liable to crack. 

When a fissure exists, it is best first to see whether 



l6o HYGIENE OF THE NURSERY 

or not nursing can be continued by means of a 
nipple-shield. Should the child refuse this, a good 
plan is to fill the shield with warm milk and invert 
it over the nipple. The infant then draws the fluid 
at once and without difficulty, and will often con- 
tinue sucking until the breast milk follows. After 
nursing and removing the shield, the nipple must 
be dried thoroughly with absorbent cotton, and the 
following lotion applied with a camel's-hair brush: 

Take of — 

Boracic acid 20 grains. 

Mucilage of acacia 1 fluidounce. Mix. 

Mammary abscess requires careful surgical 
attention. 

b. On the part of the infant, there are several in- 
dications for anticipating the time of withdrawing 
the mother's breast, but this is always a serious 
matter and must never be advised without most 
careful consideration. 

The occurrence of pregnancy during lactation 
necessitates immediate weaning, but this is by no 
means the case with the re-establishment of men- 
struation. Usually the function of the breasts stops 
on the return of the monthly flow, and sometimes, 
while secretion continues, the milk is so altered in 
quality as to be unfit for food ; but, at others, though 
the quantity may be diminished, the quality is 
unchanged and the infant keeps well and gains 



FOOD l6l 

steadily between the periods. Under these con- 
ditions the baby should be kept at the breast, 
though it may be advisable, during the first day 
or two of menstruation, to feed partially or entirely 
from a bottle. Premature weaning is also necessary 
if the mother contracts a dangerous contagious 
disease, as small-pox, scarlet fever, or erysipelas; 
if the mammary glands become inflamed; if the 
breast does not afford sufficient nourishment and 
artificial food be refused; and, finally, if dentition 
be markedly delayed and the premonitory symptoms 
of rickets appear. As to the amount of nourish- 
ment, it must be remembered that the breast 
milk may be of good quality, but so diminished in 
quantity that it is insufficient; or, while abundant 
in quantity, so poor in quality that it does not meet 
the demands of nutrition. Even without a minute 
examination of the milk, it is possible to form a 
good idea of which condition is present from the 
behavior of the infant in the act of sucking. If 
the milk be good in quality but deficient in quantity, 
the baby, when put to the breast, seizes the nipple 
as if famished and draws upon it vigorously for 
a time, and then drops it with a scream of rage. 
On the contrary, should there be an abundant 
supply of poor milk, the nipple is grasped languidly, 
the child lies a long time at the breast and falls 
asleep there. Consideration of the final indication 



1 62 HYGIENE OF THE NURSERY 

opens the question of the propriety of regulating 
weaning by the progress of dentition. This is 
certainly a good guide, but not in the way im- 
plied in the old precept, that the child must not 
be taken from the breast until evolution of the 
stomach and eye teeth. Insufficient food is one of 
the chief causes of rickets, and rickets more than 
any other disease delays dentition; consequently, 
should the teeth not pierce the gum in time, the 
inference is for other food rather than a continuance 
of the faulty maternal supply. In this connection 
one must remember what has already been stated 
in regard to "mixed feeding," and if the breast 
secretes only enough milk of good quality to serve 
for two or three daily feedings, even so little must 
be carefully conserved during the earlier months of 
life and the deficiency made up by a properly modi- 
fied cow's milk mixture administered from a bottle. 
When the mother's milk so disagrees as to war- 
rant withdrawal of the breast, the baby does not 
thrive, ceases to gain weight or loses steadily, 
and presents the evidences of disordered digestion. 
It may vomit or eructate, though the symptoms 
being, as a rule, intestinal rather than gastric, 
there are, usually, discomfort, constant crying, 
poor and restless sleep, distention of the abdomen, 
colic, frequent expulsion of flatus from the bowel, 
sometimes constipation but usually diarrhoea, with 



FOOD 163 

loose green evacuations containing mucus and 
passed with much gas. 

Habitual vomiting does not necessarily indicate 
weaning. In such cases an effort must be made 
to overcome the trouble before resorting to extreme 
measures. If vomiting occurs soon after nursing, 
it may simply mean that the infant has taken too 
much food, therefore, shorten the time of lying at 
the breast, give one breast only, and interrupt the 
sucking by short periods of rest, thus preventing 
too rapid feeding. Vomiting taking place some- 
time after nursing and repeated, is often due to 
the milk being too rich in fat, and may be overcome 
by increasing the intervals between nursings, or 
by giving, from a feeding bottle, immediately 
before each meal one or two tablespoonfuls of 
pure boiled water, lime-water and water, or barley- 
water. When there is constant colic the milk is too 
rich in proteids, and the mother should take more 
exercise in the fresh air, eat less meat, avoid worry 
and control her emotions. The element of constipa- 
tion associated with colic can be but little influenced 
through the mother's milk. 

Where all expedients fail and one is reasonably 
sure that the only proper course is to anticipate 
the time of weaning, the next point to consider is 
whether the infant shall be brought up by hand or 
by a wet-nurse. 



164 HYGIENE OF THE NURSERY 

2. Feeding by a wet-nurse. — The advantage of 
feeding from the breast of a wet-nurse is that the 
mother's milk is substituted by the milk of another 
woman; in other words, that natural feeding is con- 
tinued — a matter of moment in all cases, and of in- 
estimable importance with delicate children. The 
disadvantage consists in the difficulty of finding, in 
a woman belonging to the class from which wet- 
nurses come, all the moral and physical characters 
essential to a good substitute, and the fact that a 
stranger is introduced into the household, often to 
deceive and annoy the family, and on the slightest 
provocation to leave her charge to fate or to the 
tender mercies of another of her kind. For these 
reasons it is preferable, in the majority of instances, 
to trust to careful bottle-feeding. Nevertheless, as 
some children must have human milk if their lives 
are to be saved, the rules for selecting a wet-nurse 
must be understood. 

The woman chosen must be strong and robust, 
but rather spare than fat. Her bill of health must 
be perfectly free from hereditary tendency to men- 
tal or physical disease and from taint of syphilis or 
tuberculosis. She must be cheerful, good-natured, 
active, careful, and temperate in habits. Her age 
should be between twenty and thirty years; she 
should understand the care of an infant and the 
manner of giving suck; her child ought to be of 



FOOD 165 

nearly the same age as the infant to be adopted, 
and she must be able to afford an abundant supply 
of good milk. 

The last quality can be estimated by inspecting 
the breast, by examining some of the milk drawn 
by a pump, and by ascertaining the condition of the 
woman's own child. The breasts of a good nurse 
are not necessarily large, but are firm to the touch 
and pyriform in shape, with well developed, promi- 
nent nipples, and with the skin distinctly marbled 
with large blue veins. The milk, which ought to 
flow readily on pressure or on suction, should be 
opaque and dull white in color, have a specific 
gravity of 1.031, an alkaline reaction, show, when 
placed under the microscope, a number of minute, 
equal-sized, fat globules, and yield on analysis a 
normal percentage of fat, proteids and sugar. Its 
quantity may be ascertained by weighing the child 
before and after sucking, the normal gain being 
from three to six ounces. There is, however, no 
better or more readily applied test of the quality 
of a nurse than the size, weight, and general devel- 
opment of her own child; and if it be weak and ill- 
nourished, no amount of fitness in other respects 
can warrant her engagement. 

Even when a woman is found fulfilling in her 
single person all the required conditions — a rare 
thing, indeed — it does not necessarily follow that 



1 66 HYGIENE OF THE NURSERY 

her milk will suit the baby to be suckled. Then 
changes and new trials must be made until the 
desired end be attained. 

The diet of a wet-nurse and the manner of wean- 
ing must be governed by the rules already given for 
maternal feeding. 

Personally, I have had such good results from 
carefully regulated bottle feeding that I have, as 
far as possible, given up the emloyment of wet- 
nurses, preferring to regulate the artificial food 
myself rather than allow an ignorant woman to 
supplement surreptitiously her deficient supply of 
breast milk by an unskilfully proportioned food — 
an event of not uncommon occurrence. 

3. Artificial feeding. — In my experience there 
are few American women, especially in the well-to- 
do classes, who do not look upon the duty of nursing 
their babies as a pleasant one; but there are many 
who are completely unable to do so, and a vast 
number in whom the secretion of milk fails after 
a few weeks or months of lactation. They must, 
therefore, through no fault of their own, resort to 
a wet-nurse or to artificial feeding. Usually they 
select the last method, with results that vary in 
direct proportion to the care and intelligence dis- 
played in carrying it out. 

There is no artificial food equal to the milk of a 
robust woman. The fluid, however, secreted from 



FOOD 167 

the glands of a feeble or unhealthy mother, though 
often sufficient in quantity to fill the suckling's 
stomach and satisfy the cravings of hunger, does 
not contain enough pabulum to meet the demands 
of nutrition. In such unfortunate cases, good 
cows' milk, properly prepared, is a better food 
than the bad breast milk. More care and trouble, 
though, are involved in bottle- than in breast- 
feeding. If the child has been nourished in the 
natural way — i. e., breast-fed — even for a few 
weeks, or when the powers of digestion are inher- 
ently active, the task is far easier to accomplish. 
In these cases the stomach and intestinal canal, 
inactive in fcetal life, are trained to their new duties 
under normal conditions, and so prepared for the 
digestion of properly selected artificial food. On 
the contrary, if digestion be naturally feeble, or if 
the infant must be bottle-fed from the first, great 
difficulty may be expected, and most skilful hand- 
ling is necessary. 

To insure success in hand-feeding, it must be 
remembered that an infant is not nourished alone 
by the food he swallows, but by that portion of it he 
digests and assimilates. The best diet, therefore, 
is one so adapted to age and digestive power that 
everything eaten will be digested and absorbed. 
But as children differ as much in constitution as in 
feature, it is impossible to formulate exactly a food 



1 68 HYGIENE OF THE NURSERY 

that will be applicable to every case, or one that 
needs no change from month to month of progress- 
ing growth. As age and strength increase, there 
is a corresponding development of the gastrointes- 
tinal functions and a demand for more and stronger 
food. On the other hand, should the system be 
accidentally reduced by disease, the digestion, sym- 
pathizing in the general debility, temporarily loses 
its normal activity and assumes that of an earlier 
age. In such a case more nourishment is certainly 
needed to build up the failing strength, but it is to 
be supplied by giving such food as can be com- 
pletely assimilated, and not by forcing down strong 
food merely because it is strong; for the latter, 
when not vomited, passes through the bowels un- 
digested, and the little creature starves to death in 
the midst of plenty, or dies from the ill effects of 
the constant presence of fermenting food in the ali- 
mentary canal. On these accounts many changes 
in diet, as to quality and quantity, must be antici- 
pated and made. 

Important matters, therefore, to be studied in 
detail are: a, the selection of a proper substitute for 
the breast milk; b, the quantity to be given; c, the 
method of preparation; d, the mode of administra- 
tion; and, e, the means of preservation. 

a. Healthy breast milk must be taken as the 
type of infant's food, and the nearer an artificial 



FOOD 169 

substitute can be made to approach it in chemical 
composition and physical properties, the more 
perfect it is. 

Normal breast milk has a specific gravity of 1.03 1. 
It is a persistently alkaline fluid, having a some- 
what animal, usually disagreeable, and very rarely 
sweetish taste. It is bluish-white in color, thin and 
watery in consistence, and contains no bacteria. 

According to recent analyses, its average com- 
position is: 

Fat 4.00 per cent. 

Milk sugar (lactose) 7 .00 per cent. 

Proteids 1.50 per cent. 

Salts 0.20 per cent. 

Water 87 .30 per cent. 

Some authorities give a higher albuminoid average, namely, 2 per 
cent.; but, as will be detailed later, the proportion of this ingre- 
dient varies greatly, and it is safe to assert that a range from 
1. 00 to 2.25 per cent, is perfectly normal. 

Human milk contains, then, fat, nitrogenous 
material, sugar, salts and water — all the elements 
essential to repair tissue waste, to supply new 
material for growth, and to maintain body heat, or, 
in other words, to constitute a perfect aliment; 
and these, too, are so proportioned in the combi- 
nation as to most easily and completely meet the 
demands. 

It must not be supposed, however, that the 



170 HYGIENE OF THE NURSERY 

elements are uniformly present in the same pro- 
portion. On the contrary, the fluid varies both 
at different periods of lactation and in different 
individuals. 

This fact is the most striking feature of Professor 
Leeds' experimental work, which shows that the 
most changeable constituent is the proteids, vary- 
ing from a maximum of 4.86 per cent, to a minimum 
of 0.85; the next are the fat and salts, the maximum 
being about three times the minimum, and the least 
the sugar. The latter, in fact, varies but little from 
a standard of about 7 per cent. The function of 
the proteids is nutritive, that of milk sugar calori- 
facient; hence, the point seems to be that nature, 
while allowing a wide range of oscillation in the 
rapidity of tissue building, carefully provides an 
available fuel for the constant maintenance of animal 
heat — the supply of caloric due to cerebral impulses 
and self-originated locomotion being extremely 
small in early infancy. 

In seeking a substitute for human milk, one natur- 
ally turns to the domestic animals for the source of 
supply. Between the milk of the ass, cow, goat and 
ewe there is little choice, so far as composition is 
concerned, although, perhaps, asses' milk resembles 
that of women a little more closely than the others; 
nevertheless, cows' milk is usually selected, because, 
being plentiful, it is easily obtained and cheap. 



FOOD 171 

Cows' milk* (market milk) has a specific gravity 
of 1.027 to 1.035, i s richer looking, that is, whiter 
and more opaque than human milk, is slightly acid 
in reaction unless perfectly fresh from pasture-fed 
animals, when it may be neutral or alkaline, and 
always contains bacteria. It has the following 
average composition: 

Fat 4.0 per cent. 

Milk sugar 5.0 per cent. 

Proteids 3.5 per cent. 

Salts 0.7 per cent. 

Water 87.0 per cent. 

* The character of cows' milk may be determined with sufficient 
accuracy in the following way: 

Provide a specific gravity glass, such as is shown in Fig. 18, 
and which can be obtained at any chemist's, or a lactometer may 
be used. To obtain the specific gravity, fill a beaker to such a 
point with milk that it will float the specific gravity glass or 
lactometer, and read the degree of density from the scale at a 
level with the surface of the milk. The chemical reaction is 
found by inserting a piece of blue litmus paper, which should 
turn slightly red a few moments after being wet. In applying 
this test small pieces of litmus paper should be examined under 
and in the milk, as exposure to air may redden paper dipped in 
milk, although the fluid itself may not be acid. To ascertain the 
proportion of cream, cut a narrow strip of paper four inches 
long, and divide the upper half-inch, by cross-markings, into 
twelve equal parts; paste this on a beaker (Fig. 18) with the 
marked portion uppermost, and the lower edge coming accurately 
to the bottom of the beaker; then pour in enough milk to come 
just to the lop of the paper, and place the whole aside for twenty- 
four hours. During this time the cream rises and appears as 



172 



HYGIENE OF THE NURSERY 



Comparing this analysis with that previously 
given for human milk, it is readily seen that the 
two fluids differ in specific gravity and reaction, and 
that cow's milk contains more nitrogenous material 
but much less sugar than woman's 
milk. 

While the sugar of human and 
cows' milk is chemically identical, 
and the fats are quite similar, there 
are important differences in the 
quality as well as the quantity of 
the nitrogenous material. This in 
both fluids is complex, being made 
up of casein, lactalbumin, and 
peptones. The peptones are pres- 
ent in very small quantities only, 
and to what extent they exist 
naturally, and to what, in cows' 
milk, they are formed by bacterial 
action, is not known. 
Casein is an acid substance, and is present in 
combination with an alkali, chiefly as potassium 
caseinate. The casein of cows' milk is readily pre- 
cipitated by dilute acid, and is thrown down in large 
firm masses; that of human milk requires more acid 

a yellow layer at the top; this layer should have the depth of 
ten or twelve spaces. Beakers with a scale cut in the glass are 
now sold in instrument shops under the name of "creamometers." 



Fig. 18. — Specific 
Gravity Glass 
and Cream 
Beaker. 



FOOD 



173 



and is precipitated in fine, soft particles, which are 
dissolved by an excess of acid. After the separation 
of the casein, the lactalbumin is left in solution in 
the whey. Lactalbumin closely resembles serum 
albumin, is unaffected by acid, but is precipitated 
by boiling. 

The relative proportions of casein and lactalbumin 
have been determined with sufficient accuracy to 
point out the most important of all the differences 
between the two secretions, which is, that the frac- 
tion of the total albuminoids in cows' milk which 
is coagulable by acids (casein) is far greater than the 
non-coagulable part (lactalbumin). In woman's 
milk, on the contrary, the reverse is true, and the 
non-coagulable part much exceeds the coagulable 
portion. The following table shows this difference: 





Human 
milk. 


Cow's 

milk. 


Total proteids... 


1.80 
0.60 

1 .20 


3-5° 
3.00 
0.50 


Lactalbumin .... 



Taking weight for weight of each secretion, the 
coagulum of human milk is only one-fifth that of 
cows' milk. This difference is readily tested by 



174 HYGIENE OF THE NURSERY 

adding rennet to the two fluids. In the case of 
cow's milk the casein is coagulated into large, firm 
masses, while with human milk a light, loose curd 
is formed. In the stomach the acid gastric juice 
has the same effect, producing in the first in- 
stance a coagulum most difficult to digest; in the 
other, one of vastly less bulk and readily attacked 
and broken down by the gastro-intestinal solvents. 

These chemical and physical properties of cows' 
milk can be altered by various methods of prepa- 
ration, and unless this be done there are few in- 
stances in which it will not prove a poor substitute 
for the natural food. 

Condensed milk is frequently recommended by 
physicians and largely used by the laity on their 
own responsibility. It keeps better than cows' milk 
and is supposed to be more readily digested by 
young infants. The latter supposition is a mis- 
taken one, and arises from the overlooked fact that 
condensed milk is always given dissolved in a large 
proportion of water (i part to 1 2-10-8 or 6, according 
to the age of the child), while cows' milk is too fre- 
quently used insufficiently diluted or otherwise im- 
properly prepared. The author is convinced of the 
accuracy of this statement from a number of years' 
close study of the subject. 

Condensed milk contains a large proportion of 
sugar, forms fat quickly, and thus makes large 



FOOD 175 

babies; sugar also counteracts in some degree 
the tendency to constipation — often a troublesome 
complaint in hand-feeding. These advantages are 
unquestioned, and, together with the ease of prepa- 
ration and the fact that, when in good condition, it 
is sterile or free from bacteria, are those which place 
it so high in the esteem of monthly nurses. It is 
equally true, however, that prepared as a food it 
does not contain enough nutrient material, either 
in the form of fat or proteids, to supply the wants 
of a growing baby. 

Again, more than half of the saccharine ingre- 
dient of this preparation is cane sugar, added for 
the purpose of preservation, and this material is 
very liable, when in excess, to ferment in the ali- 
mentary canal, giving rise to irritant products that 
impede digestion. 

Infants fed upon condensed milk, though fat, are 
pale, lethargic and flabby; although large, are far 
from strong; have little power to resist diseases; 
frequently develop scurvy; often cut their teeth late, 
and are very likely to drift into rickets. It must be 
remembered also that condensed milk, when long 
kept, or when packed in imperfect cans, not unfre- 
quently undergoes decomposition, and thus becomes 
utterly unfit for use. 

For a temporary change of diet, and as a sub- 
stitute during traveling or under circumstances in 



176 HYGIENE OF THE NURSERY 

which sound cows' milk cannot be obtained, it may 
be resorted to with advantage. Again, for feeding 
very young infants when a sterile food of low 
albuminoid percentage is indicated, it may some- 
times prove useful, but the necessity of adding 
fat, in the form of cream, must always be insisted 
upon. 

The farinaceous substances so often selected, 
especially by the poor, to replace breast milk, are 
not only bad foods, but have both directly and in- 
directly a deleterious effect upon the processes of 
nutrition. 

They are bad for two reasons. First, they differ 
materially in chemical composition from human 
milk. For example, in arrowroot, which is the 
favorite, the proportion of the tissue-building to the 
heat-producing element is as one to twenty, while 
in human milk it is about one to five. Second, the 
heat-producing principle, starch, must be converted 
into sugar before it can be absorbed. This change 
is accomplished in the body by the saliva and pan- 
creatic juice — secretions that are not fully estab- 
lished until the fourth month. 

While the starch lies undigested in the gastro- 
intestinal canal, it is subject to fermentation, result- 
ing in the formation of irritant products that rapidly 
induce catarrh of the mucous membrane — a con- 
dition directly interfering with the digestion and 



FOOD 177 

absorption of food. Again, perfect nutrition de- 
mands rapid waste and removal of effete tissues 
as well as repair of the same. This is effected by 
oxidation. Now, sugars are known to have a much 
greater affinity for oxygen than albuminoids, and 
when the diet consists of farinaceous material, the 
small amount of sugar formed and absorbed appro- 
priates oxygen that otherwise would go toward the 
removal of waste, and so retards the necessary 
changes. The persistent and exclusive use of this 
class of food always leads to a condition of mal- 
nutrition which may result in simple atrophy, scurvy 
or rickets, while the irritant products of fermenta- 
tion often produce sufficient gastro-intestinal dis- 
turbance to cause death. 

Farinaceous food, as such, is therefore never per- 
missible before the later months of infancy, and 
then only as an adjunct to properly modified milk 
mixtures. It may be employed earlier for its 
mechanical action, with milk mixtures, and in 
properly selected cases proves very useful in this 
way. The purpose of this method of employment 
will be considered later under the head of Atten- 
uants. 

The nutrient value of the cereals and their prod- 
ucts, as they exist in so-called "infants' foods," 
has been imperfectly determined. They are un- 
doubtedly useful as mechanical attenuants, but it 



178 HYGIENE OF THE NURSERY 

is very certain that none of them, unless prepared 
with milk, can permanently meet the demand of 
nutrition. At the same time it is quite probable 
that the albuminoids with the soluble carbohy- 
drates (maltose) obtained by Liebig's process have 
a food value of their own, making them more 
serviceable than the starches. 

b. The quantity of food to be allowed each day 
varies with the appetite and age. Some infants 
habitually eat little, others much; as both thrive, 
the question of the correct amount in a given case 
must be answered by observation. So long as the 
child develops with normal rapidity and keeps well 
he may be allowed to eat as much or as little as he 
wants; for, if food of proper strength be given at 
proper intervals, the instinctive cravings of hunger, 
since they represent the wants of the system, rarely 
lead to excess in either direction. Nevertheless, it 
is well to have some guide. 

During the first four weeks, infants generally 
require from twelve to seventeen fluidounc.es of 
food; in the second and third months, about thirty 
fluidounces, and from this time to the twelfth 
month from two to two and one-half or even three 
pints. After the twelfth month the quantity 
depends upon whether additions be made to the 
diet, or milk food be used exclusively. When the 
daily amount reaches three pints, the limit of the 



FOOD 179 

capacity of the stomach is usually attained, and 
the greater demand for nutriment, as growth ad- 
vances month by month, must be met by adding 
to the strength of the food rather than by increasing 
its bulk. These two factors, strength and quantity, 
are intimately associated throughout the whole 
period of infancy, and in the earlier months a mere 
increase in the latter is not always sufficient to 
maintain the balance of nutrition. 

As a rule, infants are overfed, and this opens the 
very interesting question of the normal capacity of 
the stomach at different ages. Rotch states that, 
by actual measurement, the stomach of an infant 
five days old holds 25 c.c, or six and one-quarter 
fluidrachms, a quantity very far short of that usu- 
ally forced upon the baby during the first week. 
Frowlowsky's investigations show that there is a 
very rapid increase in the capacity of the stomach 
during the first two months of life, while in the 
third, fourth and fifth months the increase is slight. 
Guided by these data, the quantity of food should 
be rapidly augmented during the first six or eight 
weeks of life and then held at the same quantity up 
to the fifth or sixth month. Another considerable 
increase is also demanded between the sixth and 
the tenth months. 

The author has been unable to verify the above 
measurements, and has, on the contrary, found no 



i8o 



HYGIENE OF THE NURSERY 



uniformity in the size of the stomach for given ages; 
still clinical experience is a sufficient guide, and 
upon this the following table is based: 



TABLE OF INTERVALS OF FEEDING AND AVERAGE AMOUNTS 
OF FOOD. 



Age. 


Intervals 

of 
feeding. 


Average amount 
at each 
feeding. 


Average amount 
in 24 hours. 


During first week. . . . 


2 hours. 


1 ounce. 


12 ounces. 


From second to sixth 
week. 


2 hours. 


i£ to 2 ounces. 


12 to 17 ounces. 


From sixth week to 
third month. 


2 hours. 


3 to 4 ounces. 


24 to 30 ounces. 


From third to sixth 
month. 


2\ hours. 


4 to 6 ounces. 


32 to 36 ounces. 


At ten months [ 3 hours. 


8 ounces. 


40 ounces. 



c. The object to be accomplished in the prepara- 
tion or modification of cows' milk is to make it re- 
semble human milk as much as possible in chemical 
composition and physical properties. To do this 
it is necessary to reduce the proportion of proteids, 
to increase the proportion of sugar, and to overcome 
the tendency of the casein to coagulate into large, 
firm masses upon entering the stomach and coming 
in contact with the acid gastric juice. 



FOOD 181 

Dilution with water is all that need be done to 
reduce the amount of proteids to the proper level; 
but as this diminishes the already insufficient sugar, 
and also the fat, it is essential to add these materials 
to the mixture of milk and water. Fat is best added 
in the form of gravity cream which contains approx- 
imately 16 per cent, of fat; and of the sugars, either 
pure white loaf sugar or sugar of milk of good 
quality may be used. The latter is greatly pref- 
erable, because it is the natural sugar, is directly 
assimilable, in the process of digestion is converted 
into lactic acid, and, unlike cane sugar, is not 
readily fermented. One ounce of milk sugar to 
twenty ounces of food properly proportioned 
for the first four months, gives a sugar percent- 
age similar to human milk, i. e., 6 to 7 per cent. 
If cane sugar be used, one-half the quantity is 
required. 

Firm clotting may be prevented by the addition 
of an alkali or a small quantity of some thickening 
substance or attenuant. 

Lime-water is the alkali usually selected. It 
neutralizes the slightly acid reaction which usually 
characterizes market milk and has a further chemi- 
cal action which is variously explained. Some 
authorities claim that to the extent of the quantity 
of lime-water added a soluble calcium caseinate is 
formed which is not acted upon by the acid gastric 



182 HYGIENE OF THE NURSERY 

juice with the precipitation of firm curds. Others, 
that lime-water causes the mucoid proteids (Storch) 
of the milk to swell up and become viscid, thus 
tending to gelatinize the curd, and by its alkaline 
properties to retard the curdling action of the gas- 
tric secretion. Whichever theory is accepted the 
result is the same, the total bulk of casein coagulum 
is diminished and the ease of digestion increased. 
To produce measurable results the quantity of 
lime-water to be used must always be in the propor- 
tion of one part to twenty of milk mixture. When 
lime-water is constantly employed, it becomes quite 
an item of expense if procured from the chemist's. 
This outlay is unnecessary, for it can be made quite 
as well in the nursery. Take one heaping teaspoon- 
ful of slaked lime and put it with one quart of 
boiled or distilled water into a bottle, cork securely, 
and shake thoroughly two or three times, at intervals 
of half an hour; then allow to settle and after 
twenty-four hours siphon off for use the upper 
clear fluid; this must be kept in a well-stopped, 
perfectly clean bottle. 

Instead of lime-water, bicarbonate of sodium may 
be added to each bottle in the proportion of one 
grain to each fluidounce of milk mixture; or, better 
still, from five to fifteen drops of the saccharated 
solution of lime. This solution is made in the 
following way : 



FOOD 183 

Take of— 

Slaked lime 1 ounce. 

Refined sugar, in powder 2 ounces. 

Distilled water 1 pint. 

Mix the lime and sugar by trituration in a mortar. Transfer the 
mixture to a bottle containing the water, and having closed this 
with a cork, shake it occasionally for a few hours. Finally, 
separate the clear solution with a siphon and keep it in a 
stoppered bottle. 

Thickening substances, attenuants, are employed 
to act in the main mechanically by getting, as it 
were, between the particles of casein during coagu- 
lation, preventing their running together and form- 
ing a large compact mass. This class embraces 
gummy materials like dextrin, gelatin, the various 
infants' foods prepared by Liebig's process (in 
which the starch of wheat and barley is converted 
into maltose and dextrin), and finely divided starch 
as it exists in barley- or oatmeal-water; and it is for 
this purpose only that starch is permissible as an 
clement of diet in infancy. Barley-water and gela- 
tin* are the attenuants usually employed. 

When an "infant's food" is used to act mechanic- 
ally, care should be taken to select a reliable one, 
that is, one in which the starch has been converted 
into maltose and dextrin by the process of manu- 
facture. The articles known as Mellin's Food and 
Ilorlick's Food can be relied upon. One teaspoon- 

* See Chapter IX. 



184 HYGIENE OF THE NURSERY 

ful of either dissolved in a tablespoonful of hot water 
and added to each portion of food, makes a very easily 
digested mixture. Dry malt extracts also act well 
mechanically, being especially useful when desirable 
to reinforce the fat-building elements of the food. 

It must not be inferred from what has been stated 
in regard to the use of lime-water and attenuants 
that these are essentials in the artificial feeding of 
infants. On the contrary, the majority of healthy 
babies require only sound cows' milk, properly 
modified by the addition of cream, milk sugar, and 
water. It is best to leave the addition of lime- 
water, bicarbonate of sodium, or an attenuant, to 
the judgment of the physician. 

For the successful management of children, the 
mother or nurse must not only be familiar with the 
theory of feeding, but must practically understand 
the methods of preparing food. To this end a 
schedule of the diet of an infant from birth upward, 
with a sketch of the modifications that have to be 
made most frequently, will serve as a useful guide. 

Diet during the first week: 

Gravity cream* (16%) . . 2 teaspoonfuls. 

Whey 3 teaspoonfuls. 

Water, qS -ioo° F 3 teaspoonfuls. 

Milk sugar J teaspoonful. 

* Gravity cream is obtained by skimming after milk has stood 
for twenty-four hours. Ordinary centrifugal cream has 18-20 per 
cent. fat. Heavy centrifugal cream has 35-40 per cent. fat. 



FOOD 185 

For each portion; to be given every two hours from 5 A.M. to 
n p.m., and in some cases once or twice at night; amounting 
to twelve fiuidounces of food per diem. 

Diet from the second to the sixth week: 

Gravity cream (16%) . . . 2 teaspoonfuls (fid. oz. \). 

Milk 1 tablespoonful (fid. oz. £). 

Milk sugar $ teaspoonf ul. 

Water 2 tablespoonfuls (fid. oz. 1). 

For one portion; to be given every two hours from 6 A.M. to 10 
p.m. and once during the night; amounting to seventeen fluid- 
ounces of food per diem. 

Diet from the sixth week to the end of the second 
month: 

Gravity cream (16%) . . . 1 tablespoonful (fid. oz. £). 

Milk 2\ tablespoonfuls (fid. oz. i\). 

Milk sugar \ teaspoonf ul. 

Water 2\ tablespoonfuls (fid. oz. i\). 

For each portion; to be given every two hours; amounting to 
thirty fiuidounces per diem. 

Diet from the beginning of the third month to the 
sixth month: 

Gravity cream (16%) ... 1 tablespoonful (fid. oz. £). 

Milk 4 tablespoonfuls (fid. oz. 2 ). 

Milk sugar 1 teaspoonful. 

Water 3 tablespoonfuls (fid. oz. ij). 

For each portion; to be given every two and one-half hours; 
thirty-two fiuidounces per diem. 



l86 HYGIENE OF THE NURSERY 

Diet during the sixth and seventh months; six 
meals daily: 

Gravity cream (16%) .. . i tablespoonful (3d. oz. £). 

Milk 7 tablespoonfuls (fid. oz. 3J). 

Milk sugar 1 teaspoonf ul. 

Water 4 tablespoonfuls (fid. oz. 2 ). 

For each portion; to be given every three hours from 6 or 7 a.m. 
to 9 or 10 P.M.; thirty-six fluidounces per diem. 

Often a pinch — gr. 2 to 5 — of table salt is of 
service, and may be added, after the second week, 
to each portion of food. 

A table of the dietary, as far as it has been carried, 
may be useful for convenience of reference (page 
187). 

Throughout the eighth and ninth months five 
meals a day will be sufficient, each meal composed 
of 

Gravity cream (16%) ... 1 tablespoonful (fid. oz. £). 

Milk 12 tablespoonfuls (fid. oz. 6 ). 

Milk sugar 1 teaspoonful. 

Water 3 tablespoonfuls (fid. oz. 1$). 

This allows forty fluidounces of food per diem. 

At this age it is sometimes advisable to supple- 
ment the milk mixture with one of the reliable in- 
fants' foods (Liebig foods); thus, two teaspoonfuls 
of Mellin's food may be added to the second, third, 
and fourth meals, the milk sugar being then omitted. 
Instead of Liebig food, one of the wheat or barley 



FOOD 



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Intervals 
of feeding. 




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1 88 HYGIENE OF THE NURSERY 

flours prepared by baking or by diastase digestion 
may be used. Baking at a temperature of 300 to 
400 converts the starch into dextrin; treatment 
with diastase produces maltose and dextrin. The 
best examples of the baked flours are Blair's Wheat 
Flour, Imperial Granum, and Robinson's Barley. 
In selecting a Liebig food or baked flour as an ad- 
juvant, one must be influenced by the condition of 
the infant to be fed. A baked flour is indicated 
when there is a tendency to too frequent and liquid 
faecal evacuations, as it has a somewhat astringent 
action, and is to be avoided in cases of sluggish 
bowels and constipation. Under the latter con- 
ditions a Liebig food — Mellin's, for instance — 
should be used, as a laxative action is desirable. 

Diet from the tenth to the fourteenth month, five 
meals daily: 

Gravity cream (16%) 1 tablespoonful (fld. oz. $). 

Milk 15 tablespoonfuls (fld. oz. 7^). 

Milk sugar 1 teaspoonf ul. 

(Flour-ball or barley jelly* 2 teaspoonfuls.) 

Water 3 tablespoonfuls (fld. oz. ij). 

In using flour-ball, rub two teaspoonfuls of the powder with 
a tablespoonful of milk into a smooth paste, then add a second 
tablespoonful of milk, constantly rubbing until a cream-like 
mixture is obtained; finally, stir into the mixture of cream, milk, 
milk sugar and water. 



* See Chapter IX. 



FOOD 189 

Occasionally, about the end of the first year, a 
child may require a more varied and substantial 
diet; for example: 

First meal, 7 a.m. — Milk mixture as above. 

Second meal, 10.30 a.m. — A breakfast-cupful of 
warm milk (eight fluidounces). 

Third meal, 2 p.m. — The yolk of an egg lightly 
boiled, with stale bread crumbs. 

Fourth meal, 6 p.m. — Same as first. 

Fifth meal, 10 p.m. — Same as second. 

On alternate days the third meal may consist of 
a teacupful (six fluidounces) of beef-, mutton-, or 
chicken-broth, containing a few stale bread crumbs. 

Diet from the fourteenth to eighteenth month, five 
meals a day: 

First meal, 7 a.m. — A slice of stale bread, broken 
and soaked in a breakfast-cupful (eight fluidounces) 
of milk; or two tablespoonfuls of well-cooked and 
strained porridge (oatmeal or cracked wheat), with 
two tablespoonfuls of cream and a little salt (no 
sugar); a breakfast-cupful of new milk. 

Second meal, 10 a.m. — A teacupful of milk (six 
fluidounces) with a soda biscuit or thin slice of 
lightly buttered bread. 

Third meal, 2 p.m. — A teacupful (six fluidounces) 
of beef-, chicken-, or mutton-broth, with a slice of 
bread; one good tablespoonful of rice-and-milk 
pudding. 



190 HYGIENE OF THE NURSERY 

Fourth meal, 6 p.m. — Bread and milk, strained 
porridge and cream, with milk, as at first meal. 

Fifth meal, 10 p.m. — A breakfast-cupful of milk 
with or without one tablespoonful of a good Liebig 
food. 

To alternate with this: 

First meal, 7 a.m. — The yolk of an egg lightly 
boiled, with bread crumbs; a teacupful of milk. 

Second meal, 10 a.m. — A teacupful of milk with 
a thin slice of lightly buttered bread. 

Third meal, 2 p.m. — A mashed baked potato, 
moistened with four tablespoonfuls of meat broth; 
two good tablespoonfuls of junket, with the same 
quantity of cream. 

Fourth meal, 6 p.m. — A breakfast-cupful of 
milk with a slice of bread broken up and soaked 
in it. 

Fifth meal, 10 p.m. — A teacupful of milk. 

The fifth meal is often unnecessary, and sleep 
should never be disturbed for it. Should the child 
awake at 5 or 6 a.m. he should have a cup of warm 
milk, and not be allowed to go hungry until the set 
breakfast hour. 

Diet from eighteen months to the end of two and 
one-half years, four meals a day: 

First meal, 7 a.m. — A breakfast-cupful of milk; 
a lightly boiled egg, with a little butter and salt; 
two thin slices of bread and butter. 



FOOD 191 

Second meal, 11 a.m. — A teacupful of milk with 
a plain biscuit or slice of bread. 

Third meal, 2 p.m. — A breakfast-cupful of beef-, 
mutton-, or chicken-broth; a thin slice of stale 
bread; a saucer of rice-and-milk pudding. 

Fourth meal, 6.30 p.m. — A breakfast-cupful of 
milk, with bread and butter. 
On alternate days: 

First meal, 7 a.m. — Two tablespoonfuls of thor- 
oughly cooked oatmeal or wheaten grits, with two 
tablespoonfuls of cream and a little salt (no sugar) ; 
a teacupful of milk. 

Second meal, 11 a.m. — A teacupful of milk with 
a slice of bread and butter. 

Third meal, 2 p.m. — One tablespoonful of under- 
done mutton pounded to a paste; bread and 
butter, or mashed baked potato, moistened with 
good, plain dish gravy; a saucer of junket and 
cream. 

Fourth meal, 6.30 p.m. — A breakfast-cupful of 
milk, a slice of soft milk-toast, or a slice or two of 
bread and butter. 

Diet from two and one-half to three and one-half 
years, four meals daily: 

First meal, 7.30 a.m. — One or two tumblerfuls 
of milk; a saucer of thoroughly cooked oatmeal or 
wheaten grits with cream and salt, and one or two 
slices of bread (one day old) and butter. 



192 HYGIENE OF THE NURSERY 

Second meal, 11 a.m. (if hungry). — A tumblerful 
of milk, or a teacupful of meat-broth, with a 
biscuit. 

Third meal, 2 p.m. — A slice of underdone roast 
beef or mutton, or a bit of roast chicken or turkey, 
minced as fine as possible; a baked potato thorough- 
ly mashed with a fork and moistened with gravy; 
a slice or two of bread and butter; a saucer of junket 
or rice-and-milk pudding. 

Instead of the potato, well-boiled rice or plainly 
dressed macaroni may be allowed for variety, or one 
well-cooked green vegetable — i.e ., spinach, celery, 
young onions, cauliflower, and young peas mashed 
with a fork. 

Fourth meal, 7 p.m. — A tumblerful of milk; one 
or two slices of bread and butter or of well-moistened 
milk-toast; a baked apple, or stewed prunes, or 
apples. 

An important point, often neglected, is the matter 
of drink. Even the youngest infant requires water 
several times daily, and the demand increases with 
age, so that the amount taken at one time will 
range from one to eight ounces. The drinking 
water must be as pure as possible and should not 
be too cold. In the heat of summer, however, 
water moderately cooled by ice may be allowed 
without harm. 

The fresh-strained juice of sweet oranges is a 



FOOD 193 

useful addition to the diet especially when there is 
a tendency to constipation. At the fifth or sixth 
month two or three teaspoonfuls diluted with an 
equal quantity of water and with a little sugar 
may be given an hour before the second or third 
feeding, and the quantity gradually increased as 
age advances, so that at one year the child may take 
from one to two ounces. 

The foregoing schedule must, of course, be re- 
garded as an average. Some children can bear 
nothing but milk food up to the age of two or even 
three years, and, provided enough be taken, no 
fear for their nutrition need be entertained. If a 
child be thriving on milk, he is never to be forced to 
take additional food merely because a certain age 
has been reached; let the healthy appetite be the 
guide. 

A young mother, in her solicitude to do her best, 
often finds great difficulty in adhering to simple 
rules in the diet of her child. Mrs. A., who has had 
great experience with children, having had some 
herself, tells her that the child would thrive far 
better if it ate such and such a thing, and did not 
keep to weak milk foods. Miss B. assures her that 
her cousin's last child grew much healthier after 
eating a chop with vegetables and pudding each 
day. Aunt C. comes with the announcement — 
which she breaks gently — that she knows the child 
13 



194 HYGIENE OF THE NURSERY 

is simply starving, and the ignorant nurse confirms 
the statement. 

All their seemingly convincing theories are very 
upsetting to a mother who wants only to do what 
is right. She must bear in mind, however, that 
some children can eat anything and live; but she 
does not know how much better, more robust, and 
disease-resisting they would be, did they adhere to 
a simple diet. Let her remember that the so-called 
"weak milk foods" contain those nourishing quali- 
ties to which nature, in her wisdom, has limited the 
child's powers of digestion. Therefore, young 
mothers, let well enough alone. 

Much more difficulty is experienced in feeding 
infants during the first twelve months than during 
the second. It will be well, therefore, to consider 
what would best be done in case the suggested milk 
modifications should disagree. 

If, after feeding, vomiting occur, with the expul- 
sion of large, firm clots of casein, or if there be 
diarrhoea with the expulsion of curds, the effect of 
adding lime-water or barley-water must be tried. 

For instance, at the age of six weeks, make each 
bottle of— 

Gravity cream (16%) . . . . i tablespoonful (Ad. oz. J). 

Milk 2 tablespoonfuls (fld. oz. i ). 

Milk sugar \ teaspoonful. 

Lime-water i tablespoonful (fid. oz. $). 

Water 2 tablespoonfuls (fid. oz. 1 ). 



FOOD 195 

Or of— 

Grayity cream (16%). .. . 1 tablespoonful (fld. oz. J). 

Milk 2 tablespoonfuls (fld. oz. 1 ). 

Milk sugar i teaspoonf ul. 

Barley-water 3 tablespoonfuls (fld. oz. il). 

Sometimes, particularly if there be diarrhoea, boil- 
ing makes the milk more tolerable, and in this con- 
dition it may be used instead of fresh milk in either 
of the above mixtures. Condensed milk, too, can 
be employed temporarily, making each portion of — 

Gravity cream (16%) .... 1 tablespoonful (fld. oz. £). 

Condensed milk 1 teaspoonful. 

Hot water 5 tablespoonfuls (fld. oz. 2i). 

Another good food is that recommended by the 
late Dr. A. V. Meigs. It consists of a combination 
of two parts of the cream, containing from fourteen 
to sixteen per cent, of fat; one part average milk; two 
parts lime-water, and three parts sugar-water, the 
latter consisting of seventeen and three-fourths 
drachms (about eighteen teaspoonfuls) of milk sugar 
to one pint of water. This makes an alkaline mix- 
ture with the percentage of its ingredients closely 
corresponding to human milk. 

Whey* combined with cream and barley-water is 
more readily retained and digested than any of the 
above combinations, and may be usefully employed 
whenever curds are expelled by vomiting or diar- 

* See Chapter DC. 



196 HYGIENE OF THE NURSERY 

rhcea; provided that in the latter condition there is 
not sufficient decomposition of the intestinal con- 
tents to require a no-milk diet. Whey contains a 
small amount of fat, the soluble proteids (lactalbu- 
min), the sugar and part of the salts of milk. On 
the other hand, casein is practically absent, being 
clotted by the rennet and separated in the process 
of preparation. Knowing its composition one can 
easily appreciate its value, especially when combined 
with cream. in cases where casein is digested with 
difficulty. Of course, the food value of whey is less 
than of the cows' milk from which it is made, but 
as a temporary substitute in acute indigestion and as 
an initial food in cases of inherently deficient casein 
digestion, its usefulness cannot be questioned. A 
good whey mixture for an infant of six week is — 

Gravity cream (16%) . . 2-4 teaspoonfuls (fid. oz. J-J). 

Whey 3 tablespoonfuls (fld. oz. ij). 

Milk sugar £ teaspoonf ul. 

Barley-water 3 tablespoonfuls (fid. oz. ij). 

For older children it is sufficient to double the cream and sugar 
and increase the whey and barley-water in equal quantities to 
make a five- or six-ounce bottle. With this food, too, it is 
easy to return to or institute milk feeding by substituting 
each day a small measured quantity of cow's milk for an equal 
measure of whey until the proper proportion of milk for the 
patient's age is attained, and the whey is supplanted or discarded. 

Under the same conditions that whey mixtures 
are employed the process known as predigestion 
frequently gives most gratifying results. 



FOOD 197 

Predigestion, or peptonization,* is best accom- 
plished by means of the substance called pancreatin. 
That manufactured under the name of extractum 
pancreatis by Fairchild Brothers & Foster, of New 
York, has proved most efficient in my hands. 

It is sometimes necessary to carry the artificial 
process almost or quite to complete digestion of the 
casein; more frequently partial predigestion is 
sufficient. 

For the first, put into a clean quart bottle five 
grains of extractum pancreatis and fifteen grains of 
bicarbonate of sodium (the contents of a "pepton- 
izing tube"), with four fluidounces of cool, filtered 
water; shake thoroughly together, and add a pint 
of fresh, cool milk. Place the bottle in water, not so 
hot but that the whole hand can be held in it for a 
minute without discomfort, and keep the bottle 
there for exactly thirty minutes. At the end of that 
time put the bottle on ice to check further digestion 
and to keep the milk from spoiling. The fluid 
obtained, while somewhat less white in color than 
milk, does not differ from it in taste; if however, an 
acid be added, the casein, instead of being coagu- 
lated into large firm curds, takes the form of minute, 
soft flakes, or readily broken down, feathery masses 



* The subject of peptonization is further considered in 
Chapter IX. 



198 HYGIENE OF THE NURSERY 

of small size. When the process is carried just to 
the point described, the casein is only partly con- 
verted into peptone; but every succeeding moment 
of continued warmth lessens the amount of casein 
until peptonization is complete. Then the liquid is 
grayish-yellow in color; has a distinctly bitter taste, 
and shows no coagulation whatever on the addition 
of an acid. This artificial digestion, therefore, 
may be carried just as far as circumstances indicate, 
although it is ordinarily best to stop it short of 
complete conversion, as children object to the 
markedly bitter taste, and often, on account of it, 
absolutely refuse the food. Partial peptonization, 
too, is usually sufficient to adapt the milk to ready 
assimilation. To seize the proper moment for 
arresting the process, the person conducting it must 
be told to taste the milk from time to time, and, as 
soon as the least bitterness is appreciable, remove 
the bottle from the hot water and place it upon ice 
for cooling and use. Such milk may be sweetened 
with sugar of milk, and given pure or diluted with 
water. For an infant of six weeks each meal may 
consist of — 

Peptonized milk 4 tablespoonfuls (fld. oz. 2). 

Milk sugar \ teaspoonful. 

Water 2 tablespoonfuls (fld. oz. 1). 

To this, cream may be added when desirable, and 
by diminishing the quantity of water and increasing 






FOOD 199 

that of milk the strength of the food may be made 
greater at any time. 

Although every precaution be taken, the last of 
a quantity of predigested food is very apt to grow 
bitter; and if the attendants will take the trouble, it 
is much better to peptonize every meal separately. 
This is readily done by obtaining a number of pow- 
ders of pancreatin and bicarbonate of sodium, so 
proportioned that each packet shall contain the 
proper amount for one bottle of food. For example : 

Take of— 

Extractum pancreatis 9 grains. 

Bicarbonate of sodium 24 grains. 

Mix and divide into twelve powders, and dispense in waxed papers. 
Directions. — Put one powder into a nursing bottle with two 
fluidounces of filtered water and two fluidounces of fresh 
sweet milk; shake together and keep warm in a water-bath 
for about half an hour before feeding; sweeten with half a 
teaspoonful of milk sugar. 

Partial predigestion is the most useful and most 
uniformly applicable of all the methods of modify- 
ing cows' milk for infants having feeble digestive 
powers. For this purpose I have, for many years, 
employed the material known as Fairchild's pep- 
togenic milk powder. This powder contains a 
digestive ferment, pancreatin; an alkali, bicar- 
bonate of sodium, and a due proportion of milk 
sugar. It is in no sense an infant's food, and as 
considerable heat (115 F.) is required to insure its 



200 HYGIENE OF THE NURSERY 

action, the food prepared by it is not only partially 
predigested, but also, to a certain extent, Pasteur- 
ized, a result greatly to be desired under certain 
conditions, as will be detailed later. The mode of 
employment is as follows: 

Take of — 

Gravity cream (16%) i tablespoonful (fid. oz. £). 

Milk 4 tablespoonfuls (fid. oz. 2). 

Water 4 tablespoonfuls (fid. oz. 2). 

Peptogenic milk powder. . . 1 level teaspoonful.* 

This mixture is heated over a brisk flame to 115 
F., kept at this heat, with constant stirring, for 
six minutes, and then quickly cooled to the proper 
temperature (98 F.) for administration. The stir- 
ring is best done with a food thermometer, as this 
gives a constant record of the temperature, and the 
vessel containing the mixture must be moved away 
from or nearer to the source of heat as the tempera- 
ture rises above or falls below the required point. 
In preparing each bottle separately — by far the 
better plan — the mixture should never be heated to 
the boiling point, as this checks the action of the pan- 
creatin, and all digestive action after ingestion is 
lost. On the other hand, when the whole supply 
for a day is prepared at once, the required bulk of 
powder for the quantity of milk mixture is added, 

* Measure provided with jar only to be used when preparing, 
at once, the whole quantity of food to be given in a day. 






FOOD 20I 

and the whole is heated slowly to boiling, ten minutes 
being occupied, and then quickly cooled. Here the 
object is to stop the digestion, so that the portion 
to be used later in the day may not be fully pep- 
tonized and bitter. This method has the advantage 
of effecting more perfect Pasteurization. When 
properly prepared, the resultant so-called "human- 
ized milk" presents the casein in a minutely coagu- 
lable and digestible form; has an alkaline reaction; 
contains the proper proportion of salts, milk sugar, 
and fat; is not bitter in taste; has the appearance of 
human milk, and by Leeds's analysis shows: 

Water 86 . 2 per cent. 

Fat 4.5 per cent. 

Milk sugar 7 .0 per cent. 

Albuminoids 2.0 per cent. 

Ash (salts) 0.3 per cent. 

This corresponds very closely with this observer's 
average analysis of human milk. 

The great advantages of partial peptonization 
are that the necessity for lime-water, barley-water, 
and thickening substances to keep apart the curd 
is done away with, and that, when the digestive 
disturbance requiring a careful preparation of food 
is removed, an ordinary milk diet can be gradually 
resumed by regularly diminishing the time artificial 
digestion is allowed to progress. This changes the 



202 HYGIENE OF THE NURSERY 

casein in a less and less degree, until finally it is 
taken in its natural form. 

Sometimes milk, in every form and however 
carefully prepared, disagrees, exciting vomiting, or 
causing great flatulence and discomfort, while it 
affords little nourishment. With these cases and 
also when there is acute gastric indigestion with 
repeated vomiting and fever or acute intestinal 
disturbance with fever, pain, flatulence and diar- 
rhoea, with green, liquid movements containing 
mucus and milk curds, the best plan is to withhold 
milk entirely for a time and try some other form of 
food. The following are good substitutes for an 
infant from three to six months old: 

i. Albumin-water* 6-8 tablespoonfuls (fld. oz. 3-4). 

For one portion, to be given every two hours. 

Barley-water 6-8 tablespoonfuls (fld. oz. 3-4). 

Milk sugar h teaspoonful. 

For one portion, to be given every two hours. 

2. Barley-jelly 1 teaspoonful. 

Water 8 tablespoonfuls (fld. oz 4). 

Mix and add half the white of a fresh egg. 
For one portion, to be given every two hours. 

3. Veal-broth* (h lb. of meat 

to a pint of water), 
Barley-water. . . .of each, 4 tablespoonfuls (fld. oz. 2). 
For one portion, to be given every two hours. 

4. Raw-beef juice - }" 1-2 teaspoonfuls. 

Exery two hours. 

* See Chapter IX. 
J See Chapter IX. 



FOOD 203 

While on No. 4 the patient must take from 12 to 
24 fluidounces of pure water, barley-water, or 
white-of-egg- (albumin-) water each twenty-four 
hours. These must be given in small doses at 
short intervals. For some time past I have almost 
abandoned the use of raw-beef juice, as it is very 
difficult to obtain fresh beef from which to express 
it, and the juice from cold storage beef has been 
the apparent cause of a number of cases of ptomain 
poisoning that have come under my observation. 
Substitutes that can be recommended are Wyeth's 
Beef Juice and Panopepton, both sterile prepara- 
tions; of the former twenty to thirty drops and of 
the latter half a teaspoonful about correspond to 
the dose of raw-beef juice already directed; either 
one should be diluted with one or two teaspoonfuls 
of cool water. 

All the above foods are only to be used tempo- 
rarily until the tendency to disturbance within the 
alimentary canal ceases; then milk may be gradu- 
ally and cautiously resumed. 

While the onset of acute gastric or intestinal 
disorders, and the fact that the infant does not 
thrive indicate radical changes in the food, there 
arc other minor alterations that may be made to 
meet certain symptoms which are troublesome 
without being serious. Thus, loss of appetite is 
often due to overfeeding or to the presence of too 



204 HYGIENE OF THE NURSERY 

much fat in the food mixture, and is to be met by 
weakening the food generally but especially reduc- 
ing the proportion of cream, by giving water freely 
and by increasing the intervals between feedings, 
but never by coaxing or forcing the child to take 
food. Eructation of small quantities of food imme- 
diately after feeding, results from the taking of too 
large quantities or the too rapid emptying of the 
bottle, or it may depend upon too tight clothing or 
upon so handling the baby, directly after feeding, 
as to make undue pressure upon its stomach. 
Habitual vomiting, or often repeated regurgitation 
between feedings, may be relieved by reducing the 
fat and increasing the lime-water in the food, by 
substituting milk sugar for cane or malt sugar, 
and by feeding at longer intervals. Habitual 
flatulence and colic demand a decrease of the 
sugar and proteids in the food, and the removal of 
any tendency to constipation that may exist. 

Chronic constipation requires an increase of the 
fat, though care must be taken not to carry this so 
far that other abnormal conditions result; the milk 
sugar should be replaced by some "infant food" 
containing maltose, as Mellin's Food, for example, 
and after the eighth month orange juice may be 
given once daily for its laxative effect. 

When infants who have passed the first year be- 
come affected with indigestion, it is often sufficient 



FOOD 205 

to reduce the strength of the food to a point com- 
patible with digestive powers. For instance, at 
fourteen months the food may be reduced to that 
proper for a healthy child of eight months, or even 
less. At this more advanced age, too, predigestion 
of the food is very serviceable. 

If a few grains of extractum pancreatis be added 
to a goblet of thick, well-boiled starch-gruel, at a 
temperature of ioo° F., the gelatinous mucilage 
quickly grows thinner and is soon transformed into 
a fluid, the starch having been rendered soluble by 
the action of the pancreatin; by still longer con- 
tact, the hydrated starch is converted into dextrin 
and sugar. Advantage may be taken of this prop- 
erty to render the foods containing starch assimi- 
lable. Thus, to a mixture of barley-jelly and milk, 
e. g.: 

Barley-jelly 2 teaspoonfuls. 

Milk sugar 1 teaspoonful. 

Warm milk 16 tablespoonfuls (fid. oz. 8). 

Add three grains of extractum. pancreatis, and five grains of bicar- 
bonate of sodium, and keep warm for half an hour before 
administering. 

The same process may be employed with food 
containing oatmeal, arrowroot or wheat flour, with 
a view of converting the starchy ingredients into 
digestible elements without materially altering the 
taste. 






206 HYGIENE OF THE NURSERY 

When the infant has arrived at an age to take 
meat broths, these too, when digestion is enfeebled, 
may be readily peptonized.* 

d. Success in hand feeding depends upon proper 
administration as well as careful preparation of the 
food. 

From birth up to such time as broth, bread, and 
eggs are added to the diet, all the food should be 
taken from a bottle. Even after this, as the bottle 
is a comfort and insures slow feeding, it may be 
allowed for milk preparations until the child is four- 
teen or fifteen months old, then, if he has not given 
it up of his own accord, he must be weaned from it 
and taught to drink from a cup. If persevered in 
much longer there is great risk of the "bottle habit" 
being formed, the child refusing to take food except 
from a bottle, and when finally deprived of it, will 
not drink milk during the remainder of childhood, 
both unfortunate conditions. If formed, the habit 
must be broken by withdrawing the bottle suddenly 
and completely, and allowing no food but milk, 
given from a cup, until the child takes it with 
relish. Several days starvation will overcome the 
difficulty, and no harmful result need be feared. 
During the months of bottle feeding only simple 
bottles and tips are to be admitted to the nursery. 

* See Chapter IX. 






FOOD 



207 



All complicated arrangements of rubber and glass 
tubing are not only an abomination, but a fruitful 
source of sickness and death. Rather than use 
them, it is far better to feed the infant with a spoon. 




Graduated Nursing Bottle. 



The graduated nursing bottle (Fig. 19), first sug- 
gested by myself, is a useful implement. Its interior 
surface is so shaped as to present no angles for the 
collection of milk; it is easily cleaned, and the 



208 HYGIENE OF THE NURSERY 

graduated scale is convenient for nursery use. It is 
made of transparent flint glass, so that the slightest 
foulness can be detected at a glance, and varies 
in capacity from six to twelve fiuidounces. The 
modern cylindrical, graduated bottle is even more 
readily kept clean, and is to be recommended. The 
number of bottles in use should exceed by one or two 
the number of daily feedings, the extra ones being 
on hand in case of accident. Imme- 
diately after a meal, the bottle, if not 
drained by the infant, is emptied of 
whatever quantity of food it contains, 
thoroughly washed out with cold 
water, filled with a solution of bicar- 
bonate of sodium — one teaspoonful to 
a pint of water — and placed out of 
the way in some convenient place; in the morning, 
before filling, all the bottles are carefully washed 
with hot soap suds and a bottle brush, and finally 
sterilized by immersion in boiling water for twenty 
minutes. 

The tips or nipples, of which there should also be 
several, must be composed of soft, flexible India- 
rubber, and a conical shape is to be preferred, as 
being more readily everted and cleaned; the open- 
ing at the point must be free, but not large enough 
to permit the milk to flow in a stream without 
suction. At the end of each feeding the nipple must 




FOOD 209 

be removed at once from the bottle, cleansed exter- 
nally by rubbing with a stiff brush wet with warm 
water and borax, everted and treated in the same 
way, and then placed in a covered jar containing 
boric acid solution, freshly made each day, and 
allowed to stand in a cool place until again wanted. 
When the bottles are being sterilized, the tips should 
be placed in boiling water for five minutes, and just 
before one is used it should be dipped in hot water. 
Sometimes it is important to separately prepare 
each feeding just before it is given, but, as a rule, 
it is quite safe, more accurate and much less trouble- 
some to make the whole day's supply of food as soon 
as possible after the milk has been served in the 
morning. In making the mixture the required 
quantity of boiled water is measured in a glass 
graduate and poured into a large clean vessel, the 
milk sugar is then added and dissolved, then the 
cream and milk, all carefully measured, and the 
whole thoroughly mingled by stirring. Next the 
prescribed quantity for each meal is poured into 
separate bottles, and these being carefully stopped 
with cotton, are placed in the nursery refrigerator 
until wanted. When feeding time arrives a bottle 
is taken from the ice and the food heated to a tem- 
perature of about 98 F. This is done by steeping 
the bottle in hot water, or by placing it in a water- 
bath over an alcohol lamp or gas jet. Finally, re- 



2IO HYGIENE OF THE NURSERY 

move the cotton stopper, apply the tip, and the meal 
is ready. To determine that the food is of the right 
temperature for the infant to take, one must use a 
thermometer, or shake a few drops from the bottle 
upon the inner side of the wrist where it should 
feel only warm; under no circumstances should it 
be tested by inserting the tip into the nurse's or 
mother's mouth. 

The separate preparation of each feeding is to 
be recommended during the first week of life; in 
cases that are difficult to feed; when whey mixtures 
are used, and when peptogenic milk powder is 
employed and it is desirable to continue the diges- 
tive action of the pancreatin while the food is passing 
through the gastro-intestinal canal. In following 
this plan, some minutes before each feeding hour, 
so as to avoid hurry, measure the different fluid 
ingredients of the food in the graduated bottle or 
glass, add the requisite quantity of milk sugar, 
mix thoroughly by shaking or by stirring with a 
spoon, and heat as before. 

When feeding, the child must occupy a half- 
reclining position in the nurse's lap. The bottle 
should be held by the nurse, at first horizontally, 
but gradually more and more tilted up as it is emp- 
tied, the object being to keep the neck always full 
and prevent the drawing in and swallowing of air. 
Ample time, say five, ten or twenty minutes, accord- 



FOOD 211 

ing to the quantity of food, should be allowed for 
the meal. It is best to withdraw the bottle occa- 
sionally for a brief rest, and after the meal is over, 
sucking from the empty bottle must not be allowed 
even for a moment. 

e. For children residing in cities, an honest 
dairyman must be found who will serve sound 
milk and cream from country cows once every day 
in winter, and twice during the day in the heat of 
summer. The farm should be so situated that the 
consumer may be served not later than twelve hours 
after milking. The milk of ordinary stock is more 
suitable than that from Alderney, Durham, or fancy- 
bred cows, as in these the fat percentage is either 
too low or too high, varying from 2.88 to 5.21 per 
cent. The mixed milk of a good herd is to be pre- 
ferred to that from a single animal. It is less likely 
to be affected by peculiarities of feeding, and less 
liable to variation from alterations in health or 
different stages of lactation. 

The care of the herd and of the milk is of great 
consequence. The cows should be subjected to the 
tuberculin test, their condition of health should 
be guaranteed by careful and regular inspection 
by a competent veterinarian, and the milk of any 
animal failing to pass should not be mixed with 
that from healthy animals. The cows must not be 
fed upon swill or the refuse of breweries, glucose 



212 HYGIENE OF THE NURSERY 

factories, or any other fermented food. They must 
not be allowed to drink stagnant water, and must 
not be heated or worried before being milked. The 
pasture must be free from noxious weeds, and the 
barn and yard and the animals themselves must be 
neat. The udder should be washed before the milk- 
ing, and the milkers and dairy workers should be 
healthy and their hands and clothing should be kept 
clean. At the same time careful aseptic precau- 
tions must be observed with cans, pails, and every 
implement with which the milk comes in contact. 

The milk must be at once thoroughly cooled. 
This is best accomplished by placing the can in a 
tank of cold spring-water, or in ice-water, the water 
being of the same depth as the milk in the can. It 
is well to keep the water in the tank flowing; in- 
deed, this is necessary unless ice-water be used. 
The can should remain uncovered during the cooling 
and the milk should be gently stirred. The tem- 
perature should be reduced to 45 F. within an hour, 
and the can must remain in the cold water keeping 
the milk at 50 F. until the time for delivering. 

In summer, when ready for delivery, the top 
should be placed in position and a cloth wet in cold 
water spread over the can, or refrigerator cans may 
be used. At no season should the milk be frozen, 
and, on the other hand, no buyer should receive 
milk having a temperature over 65 F. 



FOOD 213 

The plan of "bottling" cow's milk and serving 
n glass jars having air-tight tops is very much better, 
and has been adopted almost uniformly, now that 
the importance of securing a pure milk supply for 
infants has been recognized and insisted upon. The 
milk so delivered should be kept at a temperature 
of 50 F. by placing the jars in a refrigerator until 
the time comes to make up the daily food mixture. 
When the milk and cream are not served in sealed 
glass jars, it is well to provide two sets of small cans, 
one set to be thoroughly cleansed and sterilized by 
boiling water while the other is taken away by the 
milkman to bring back the next supply. When this 
arrives in the morning, or in the morning and 
evening in hot weather, the milk should be strained 
through a thick layer of absorbent cotton, or cheese 
cloth, into separate and absolutely clean earthenware 
or glass vessels with secure tops, and these put at 
once into a refrigerator reserved exclusively for 
them. This may stand in some convenient spot 
near the nursery, but not in it, and especially not 
in an adjoining bath-room. With a good refrig- 
erator there is no difficulty in keeping milk at about 
50 F. and perfectly sweet for twenty-four hours in 
winter and for twelve hours in summer, except on 
intensely hot days; then it may be necessary to 
Pasteurize the whole of the supply when received, 
in order to prevent change. 



214 HYGIENE OF THE NURSERY 

As milk exists in the healthy cow's udder it is 
aseptic, but during milking and subsequent hand- 
ling and transportation it often becomes contami- 
nated by various foreign materials, both organic and 
inorganic, which either are apt to set up some in- 
jurious change in the fluid before ingestion, or give 
rise to various disturbances after entering the ali- 
mentary canal. Again, if the cows themselves be 
unhealthy, their milk may carry disease germs. 
The germs most frequently present are the bacteria 
potent in the production of diarrhceal disorders; 
the bacillus tuberculosis; and the germs of cholera, 
diphtheria, scarlet and typhoid fevers, all of which 
are readily taken up by and flourish in milk at 
ordinary temperatures. To deprive these acciden- 
tally introduced organic impurities of their activ- 
ity the milk must be subjected to sterilization. 
It must be insisted here that this process is a pre- 
ventive, and in no sense a therapeutic measure; 
that it is not to be recommended when one can be 
sure of the purity of the milk supplied and of the 
conditions for its preservation; and that milk so 
treated must be modified according to the age and 
demands of the individual case in the usual way. 
Sterilization may be conducted either at a high or 
low temperature. 

Sterilization at a High Temperature (21 2° F). — 
Several admirable implements have been devised 



FOOD 



215 



for conducting the process; one of the most simple, 
made after a design by the author, is shown in 
Fig. 21. 

This apparatus is made of tin, and consists of an 
oblong case provided with a well-fitting cover, and 
having a movable perforated false bottom (d), 







Fig. 21. — Author's Sterilizer. 

which stands a short distance above the true one 
and has attached a framework capable of holding 
ten six-ounce nursing bottles. On the outside of 
the case is a row of supports (b) for holding bottles 
inverted while drying, and at the proper distance 
below these a gradually inclining gutter (c) for 



2l6 HYGIENE OF THE NURSERY 

carrying off the drip. A movable water-bath (a) 
is hung to the side; in this each bottle of food may 
be heated at the time of administration. 

The bottles are made of flint glass and are gradu- 
ated; the graduated markings being especially 
convenient for measurement and rendering the 
use of a separate measuring-glass unnecessary, a 
matter of no little moment, as every implement 
that comes in contact with the milk in sterilization 
must be kept chemically clean. Ten bottles are 
used, so that the whole supply of milk intended for 
a day's consumption can be prepared at once. 
Each bottle is provided with a perforated rubber 
cork, which in turn is closed by a well-fitting glass 
stopper. 

Sterilization should be performed in the morning 
as soon as possible after the milk has been delivered. 
The process is as follows: First, see that the ten 
bottles are perfectly clean and dry; pour into each 
six fluidounces (12 tablespoonfuls) of milk; insert 
the perforated rubber corks, without the glass stop- 
pers, however; remove the false bottom and place 
the bottles in the frame; pour into the case enough 
water to fill it to the height of about two inches; re- 
place the false bottom carrying the bottles; adjust 
lid, and put the whole on the kitchen range. Allow 
the water to boil, and, by occasionally removing the 
lid, ascertain that the expansion that immediately 



FOOD 217 

precedes boiling has taken place in the milk; then 
press the glass stoppers into the perforated corks, 
and thus hermetically close each bottle. After 
this, keep the apparatus on the fire and the water 
boiling for twenty minutes. Finally, remove the 
false bottom with the bottles; pour out the water, 
replace, and carry the whole, covered with the lid, 
to the nursery. 

When the hour of feeding arrives, put one of the 
bottles into the attached water-bath and heat it to 
the proper point for administration. The milk 
must, of course, be diluted with filtered water, and 
receive the additions ordinarily made to adapt it to 
children of different ages. The tip used — and a 
tube must not be employed even here — should be 
thoroughly cleaned, and immersed for a few mo- 
ments in boiling water before it is attached to the 
bottle. 

As soon as a bottle is emptied — and if the whole 
of its contents be not taken, the remainder must be 
thrown away — it is washed in the ordinary manner 
with a solution of bicarbonate of sodium (one tea- 
spoonful to a pint of water) and placed in the rack 
(b) to drain and dry. 

Milk sterilized by the above process will remain 
sound for several days — according to some author- 
ities, as many as eighteen — when the heating is con- 
tinued for thirty minutes, and still longer if pro- 



215 HYGIENE OF THE NURSERY 

tracted for an hour and a half. It is especially 
useful in traveling, when fresh milk cannot be 
obtained; for use in cities during the heat of summer, 
when milk is most apt to undergo injurious changes; 
for a temporary change of food for delicate children, 
or for those suffering from diseases of the stomach 
or intestinal canal. But the experiments of Leeds 
show that sterilization at the boiling-point of water 
causes the following modifications: Casein is ren- 
dered less coagulable by rennet, and is acted on 
slowly and imperfectly by pepsin and pancreatin; 
proteid matters attach themselves to fat globules, 
and probably bring about a less perfect assimilation 
of fat; while milk sugar, by prolonged heating, is 
completely destroyed. Koplik states that "from 
the temperature of 167 F. upwards, there is a sepa- 
ration of the serum-albumin of the milk; the casein 
loses its coagulability to rennet, and at 185 F. 
amounts of rennet which for the raw condition of 
the milk are found sufficient to act, cease to be 
effective." On account of these alterations milk 
sterilized at a high temperature is difficult to digest, 
and many infants do not thrive upon it, become 
constipated, are badly nourished and anaemic, and 
often develop scurvy; hence the process should never 
be resorted to except as a temporary expedient. 

The problem, therefore, that presents itself in 
the sterilization of milk for infants' food is to devise 



FOOD 219 

a method which shall efficiently destroy the con- 
tained germs, and yet in the least possible degree 
interfere with its ready digestion and its nutritive 
qualities. This is best accomplished by: 

Sterilization at a low temperature, or Pasteuriza- 
tion. — Hueppe considers that from a physiological 
standpoint milk is best sterilized under a tempera- 
ture of 167 F., while other experimenters have 
shown that temperatures lower than 212 F., if 
continued for a short time, will destroy a very large 
proportion of the germs, and will destroy with 
certainty many pathogenic germs which find their 
way into milk either from the cow or as external 
contaminations. The elaborate experiments of 
Yersin, Granchier, Lidoux-Libard, and Bitter 
show that the bacillus tuberculosis in milk will be 
destroyed in ten minutes by an exposure to 167 F., 
in fifteen minutes to 158 F., and in thirty minutes 
to 1 54. 5 F. Concerning other bacteria, Van 
Geuns found that a few seconds' exposure to 140 F. 
would kill the cholera spirilla, the typhoid bacillus, 
and the pneumococcus. 

It may, therefore, be concluded that a tempera- 
ture of 1 55 to 160 F. maintained for thirty minutes 
will render milk sufficiently germ-free for infant 
food. It is also certain that a temperature of less 
than 1 76 F. produces no alterations in the composi- 
tion of milk that affect its digestibility. 



220 HYGIENE OF THE NURSERY 

Methods of Pasteurizing milk in bulk have been 
brought forward both in Germany and in this 
country, and now the procedure has been reduced 
to an easily managed system for household use. 
This depends upon the fact that the temperature 
of the milk to be treated may be raised to about 
the desired point (i55°-i6o° F.) by immersing a 
certain definite quantity of milk in a properly 
porportioned bulk of boiling water, the source of 
heat having been removed. A convenient appa- 
ratus for nursery use is Dr. Freeman's Pasteurizer 
(Fig. 22). 

The apparatus consists of a pail for water and a 
receptacle for the bottles of milk. The pail is a 
simple affair with a cover. Extending around it is 
a groove for indicating the level to which it is to be 
filled with water; inside are three supports (c) for 
holding the receptacle. The receptacle for the bot- 
tles consists of a number of hollow cylinders fastened 
together and surrounded by a wire (a), which rests 
on the support (c) when the milk is being heated. 
Below the wire (a) are three short wires (b); these 
rest on the supports (c) when the receptacle is raised 
for cooling. The steps of the process are as fol- 
lows: 

Fill the pail to the level of the groove with water, 
cover it, and put it on the stove to boil, the receptacle 
for the bottles having been left out. Fill the body 



of each bottle with milk or some modification of 
milk in proper proportion for feeding; stopper 







with a wad of cotton-batting and put in a refrig- 
erator. If all the bottles which the receptacle holds 
are not needed, fill the remaining cylinders with 






22 2 HYGIENE OF THE NURSERY 

cold water. When the water in the pail on the 
stove boils thoroughly, take the bottles of milk 
from the refrigerator and put them in the spaces 
in the receptacle. Pour cold water into each of 
these spaces so as to surround the body of the bottle. 
Take the pail of boiling water from the stove and 
put it on a table or mat, not on metal or stone. 
Be sure that the pail is still filled exactly to the level 
of the groove and that the water is boiling vigorously. 
Put the receptacle containing the bottles of milk 
into the pail of boiling water, so that the wire (a) 
will rest on the support (c); cover the pail quickly 
and let it stand thirty minutes. During this period 
the pail must not be on the stove and the cover 
must not be removed. Now uncover the pail and 
lift the receptacle and turn it so that the wire (b) 
will rest on the support (c), thus elevating the 
top of the receptacle above that of the pail. Put 
the whole in a basin under a faucet to which a rubber 
pipe may be attached connecting it with the pail. 
The water will overflow from the pail into the basin. 
Or the pail may be placed under a pump, fresh 
cold water being pumped into it every few minutes. 
When, however, it is not possible to cool the milk 
in this way, place the receptacle containing the 
bottles in iced water, or stand the bottles on wood 
in a refrigerator. To warm the milk for use, put 
the bottle containing it in a vessel of cold water on 



FOOD 223 

the stove, and leave it until it is warm. Use a fresh 
bottle for each feeding. Wash the bottles thor- 
oughly after using, and once a day put all the 
empty bottles in a kettle of cold water on the stove 
and let this water boil for an hour. The bottles 
should then be taken out and placed bottom up 
until used. 

A sufficiently perfect apparatus may be readily 
improvised. All that is required is a bottle-rack 
similar to that of the Arnold sterilizer, and a tin 
pail large enough to receive the rack and bottles 
and provided with a well-fitting cover. In con- 
ducting the process fill the bottles, previously per- 
fectly cleaned, with milk and stop them with cot- 
ton; place them in the rack, and this in turn in 
the pail; pour into the pail enough boiling water to 
come up to the level of the milk in the bottles; adjust 
the cover, and let the whole stand on a wooden 
table until the water becomes cool — twenty to 
thirty minutes; lastly, cool the milk quickly by 
placing the bottles in ice-water for fifteen or twenty 
minutes and then transfer to the refrigerator. The 
importance of immediate and quick cooling and 
of refrigeration after Pasteurization cannot be too 
strongly insisted upon, for if the milk be allowed 
to remain warm, or, being left about carelessly, 
again becomes warm after the sterilization, any 
germs that may find entrance multiply even more 



224 HYGIENE OF THE NURSERY 

rapidly than in raw milk and it quickly becomes a 
more dangerous food than if it had never been 
subjected to the process. The mother must re- 
member that Pasteurization is never to be employed 
when clean milk can be obtained; that its object is 
simply to render dirty milk safe, and that it does 
not insure against further deterioration or do away 
with the necessity of keeping the milk properly 
iced, and of securely stopping the bottles with cot- 
ton to prevent the re-entrance of germs. When 
thus carefully handled, pasteurized milk will keep 
perfectly sound and sweet for twenty-four hours 
at least. Its advantage as a food lies in its sterility, 
and, like ordinary milk, it must be modified by 
the addition of water, cream, and milk sugar to 
meet the special demands of each case. 

The various milk mixtures are often Pasteurized, 
the method being the same as for pure milk. 

Childhood. — Children who have cut their milk 
teeth may be fed for a twelvemonth — namely, up to 
the age of three and a half years — as follows: 

First meal, 7 a.m. — One or two tumblerfuls of milk, 
a saucer of thoroughly cooked oatmeal or wheaten 
grits with cream and salt, and a slice or two of bread 
and butter. 

Second meal, 11 a.m. (if hungry). — A tumblerful 
of milk or a teacupful of broth with a biscuit. 

Third meal, 2 p.m. — A slice of underdone roast 



FOOD 225 

beef or mutton, or roast chicken or turkey, minced 
as fine as possible; a baked potato thoroughly 
mashed with a fork and moistened with gravy, or one 
well-cooked green vegetable, as spinach, young peas 
mashed with a fork, or stewed celery, and bread and 
butter; a saucer of junket or rice-and-milk pudding. 

Fourth meal, 7 p.m. — A tumblerful of milk and 
one or two slices of well-moistened milk toast. 

Orange-juice, apple scraped with a spoon, ripe 
peaches, and cooked fruit not oversweetened, may 
be allowed, especially if there be a tendency to 
constipation. 

From three and one-half years up the child must 
take his meals at the table with his parents, or with 
some reliable attendant who will see that he eats 
leisurely. The heaviest meal must be given at mid- 
day, the supper must always be light, plenty of 
water should be taken between meals and but little 
with food, and in some delicate children, up to the 
eighth year, a glass of milk may be allowed between 
breakfast and dinner. The food, while plain, must 
be varied, and may be selected from the following 
articles: 

Milk. — Quantity required, from one and a half to two pints daily, 
including what the child drinks and takes with cereals and in 
1 food. It must be clean and fresh, not overrich in fat; 
cream to be used sparingly. Milk must not be given with 
dinner, or when ac id fruits are eaten. Butter, fresh and 
preferably unsalted, in moderate quantities and on bread. 
15 



226 HYGIENE OF THE NURSERY 

Cereals. — Coarse ground cereals are best, oatmeal, cracked 
wheat, hominy grits; these must be soaked overnight, and 
cooked for three hours in a double boiler. The prepared 
flours, corn starch, arrow-root, barley, must be cooked at least 
half an hour. Serve with cream, or milk and cream, and salt; 
sugar as little as possible, one-half teaspoonful at most, no 
syrup, or butter and sugar. Never give ready-to-serve cereals . 

Eggs. — Best with breakfast. Should be fresh and lightly and 
plainly cooked, soft boiled, poached, coddled, scrambled or plain 
omelet. 

Meat. — Give at mid-day meal. Should be broiled or roasted, 
never fried; and either scraped or cut up very fine. Choose 
chicken, lamb, mutton chops, tender beefsteak or roast beef. 
Avoid ham, sausage, pork (bacon may be taken), liver, kidney, 
cold storage or hung game and all dried or salted meats. Dish 
gravy from roast beef or beefsteak good, but made gravies are 
to be forbidden. 

Fish. — Must be fresh and boiled or baked, never fried. Those 
that are delicate, i.e., free from oil with firm short fibered flesh 
should be selected, as bass, perch, trout, flounder, sole, white 
fish. Avoid shad, smelts, salmon, cod, mackerel and halibut. 
Oysters can be given, using the soft parts only, lightly and plainly 
stewed. Other shell-fish forbidden. 

Vegetables. — White potato, baked or boiled and mashed, is 
the first vegetable to be given, serve with roast beef gravy or 
cream, not butter. Baked sweet potato may be given later. Best 
green vegetables are peas, spinach, asparagus tips, string-beans, 
celery (stewed), young beets or carrots, squash. As age ad- 
vances onions (boiled), turnips, cauliflower and tomato (baked). 
Canned peas and asparagus tips can be used. Avoid corn, lima 
beans (except when very young and tender), cabbage, eggplant, 
and raw vegetables, as celery, radishes, onion or cucumber. 
All green vegetables must be thoroughly cooked, mashed and 
strained through a coarse sieve. The appearance of small 
particles of vegetable matter in the bowel evacuations does Jiot 
mean a discontinuance of the vegetable, but simply its longer 
cooking and finer mashing and straining. 



FOOD 227 

Soups. — Meat broths better for children than vegetables, though 
after the eighth year purees of peas, spinach, celery or asparagus 
may be used. Of the meat broths, mutton and chicken are 
the best, these may be given plain or thickened with rice or barley, 
and the time to serve them is at the mid-day meal. 

Bread. — The best are ordinary wheat, bran or whole- wheat bread; 
stale, cut thin and newly dried crisp in the oven. Oatmeal, 
graham or whole-wheat crackers, unsweetened Zwieback, and 
corn bread, split and dried crisp or toasted are to be given for 
variety. Fresh bread, hot bread and fresh rolls must be avoided. 
As to cake, stale sponge cake or lady-fingers only are allowable, 
and never fresh sweet cakes, especially those that are iced or 
contain dried fruit. Buck-wheat and other griddle cakes also 
come under the ban. 

Desserts. — Junket, plain rice-and-milk pudding, a simple 
custard, and once a week a little vanilla or chocolate ice cream 
are the only made desserts to be allowed during childhood. 
Never give even a taste of pie, tart or pastry, jam, preserved 
fruits, nuts, candy or dried fruits. 

Fruits. — These are dietetically important and should be begun 
in infancy, as they have a particularly good effect in main- 
taining the activity of the bowels. They should be carefully 
selected and used in moderation, especially with city children 
and in hot weather. Up to the sixth year, cooked fruit, and 
fruit juices are given. The best cooked fruits are apples, baked 
or stewed, and stewed prunes and peaches, little sugar being 
used. Of fruit juices, that from fresh sweet oranges is to be 
preferred, but the fresh juice of grape-fruit, grapes, peaches 
and pineapple maybe used. The pulp of oranges and grape- 
fruit must not be given, but that from apples, obtained by 
scraping with a spoon, is very useful. Older children may eat 
oranges, grape-fruit, peaches, plums, apples, pears, grapes, very 
ripe cherries, cantaloupes, and, sometimes, strawberries, but the 
other fruits with small seeds, had best be avoided, so also 
watermelon and apricots. Whether bananas can be given is 
a matter of trial, some children being able to eat them with 
advantage, others quite the reverse. Fruit, especially if acid, 



225 HYGIENE OF THE NURSERY 

should not be eaten close to a meal at which milk is taken. If 
its laxative effect be desired, and in infants, fruit juice is best given 
before the first meal in the morning, or midway between two 
of the earlier feedings. In older children fruit is usually eaten 
as a dessert after the midday meal, though cooked fruit may 
be perfectly safely taken with the supper, which it serves well to 
fill out. Children should eat fruit with the least possible sugar, 
and, always, without milk or cream, and must abandon it entirely 
should it produce looseness of the bowels with mucous evacua- 
tions and abdominal pain. 
Drink. — Water only during earlier childhood, later cocoa made 
almost entirely of hot milk. Never tea, coffee, wine, beer or 
other alcoholic beverage, in any form or smallest quantity. 

The following list will give an idea of the arrange- 
ment of the meals: 

BREAKFAST. 
Every Day. One Dish Only Each Day. 

Milk. Fresh fish. Eggs, scrambled. 

Porridge and cream. Eggs, lightly boiled. Eggs, plain omelet. 
Bread and butter. Eggs, poached. Bacon. 

Sound fruits may be allowed before and after the meal, according 
to taste, as oranges, grapes without pulp (seeds not to be swallowed), 
peaches, thoroughly ripe pears, cantaloupes, and sometimes 
strawberries. 

DINNER. 
Every Day. Two Dishes Each Day. 

Clear soup. Potatoes, baked. Stewed celery. 

Meat, roasted or Potatoes, mashed. Cauliflower, 

broiled, and cut Hominy. Peas, 

into small pieces. Macaroni, plain. String-beans, young. 

Bread and butter. Spinach. Nearly all green 

vegetables. 
Junket, rice-and-milk or other light pudding, and occasionally 
ice cream, may be allowed for dessert. 



FOOD 229 

SUPPER. 
Every Day. 
Milk. 
Milk toast, or bread and butter. 
Stewed fruit, baked apple. 
Water — and this must be really pure — is to be taken freely- 
bet ween meals and should be the only drink; tea, coffee, wine or 
beer being entirely forbidden. 

Fried food, highly seasoned or made-up dishes, are to be 
excluded, and no condiment but salt is to be used. 

Eating, however little, between meals must be 
absoutlely avoided. Keep a young child from 
knowing the taste of cakes or bonbons, or, having 
learned it, let him feel that they are as unattainable 
as the thousand other things beyond his reach, and 
he soon ceases to ask for them. Even a piece of 
bread between meals should be forbidden. His 
appetite then remains natural, and he will eat proper 
food at his regular meal hours. 

As to the quantity, a healthy child may be per- 
mitted to satisfy his appetite at each meal, under 
the one condition that he eats slowly and masticates 
thoroughly. 

In case of illness, the diet must be reduced in 
quantity and quality, according to the rules that are 
applicable to adults. 



CHAPTER IX. 

DIETARY. 

In the preceding chapter so much attention has 
been devoted to the subject of the artificial feeding 
of infants, and so many formulas have been given 
for the modification of cows' milk as a substitute for 
the natural food, or human milk, that I shall only 
refer here to a few milk mixtures, some of which 
have been recommended by other writers. After 
describing these, certain methods of peptonization 
and the mode of preparing a number of dishes 
adapted to the nursery, whether occupied by well 
or ill children, will be discussed. In regard to the 
latter, however, the dishes that ordinarily come 
upon the table will not be referred to, as any good 
cook ought to know how to make them. Finally, 
a series of diets for special diseases of childhood 
will be detailed. 

MILK AND OATMEAL. 
Bethlehem oatmeal (fine 

powder) i teaspoonful. 

Water 2 tablespoonfuls (fld. oz. 1 ). 

Milk 5 tablespoonfuls (fld. oz. 2V). 

Gravity cream (16%) 1 tablespoonful (fld. oz. £). 

Sugar of milk 1 teaspoonful. 

230 



DIETARY 23I 

Heat the water just short of boiling; stir in the 
oatmeal slowly until a smooth white mixture is 
obtained and boil, in a double boiler for twenty 
minutes; then add the other ingredients. For an 
infant of three months; useful in constipation. 

MEIGS' FOOD. 

Milk 1 tablespoonful (fid. oz. h). 

Cream 2 tablespoonfuls (fld. oz. 1 ). 

Lime-water 2 tablespoonfuls (fid. oz. 1 ). 

Milk-sugar solution 3 tablespoonfuls (fld. oz. ij). 

For a child under one month; quantity to be 
increased as age advances, but no change to be 
made in quality until after the eighth or ninth 
month. 

The milk sugar solution consists of 17! drachms 
— a little over 17 teaspoonfuls of milk sugar — to a 
pint of pure water. This is the food recommended 
by the late Dr. A. V. Meigs. 

TOP MILK MIXTURES. 
"Top milk" as ordinarily used, contains 7 per 
cent. fat. To obtain it a quart bottle of milk, just 
as it is received from the dairy, is allowed to stand 
in a refrigerator for four or five hours, and then the 
upper portion is removed by a cream dipper having 
a capacity of one ounce. The quantity taken 
depends upon the grade of the milk; if poor, the 
upper 11 ounces are removed; if good average 
quality, 16 ounces; and if very rich, 22 ounces. 






232 



HYGIENE OF THE NURSERY 



It is important to remember that the top milk must 
be dipped not poured off, and that the whole quantity 
must be taken, not, only, the number of ounces 
required to make any given mixture. This milk 
when used in making a properly combined food 
mixture gives a proportion of fat to proteids of 2 to i ; 
while a similar combination made of whole milk, 
from a good mixed herd, contains equal fat and 
proteids and requires the adding of 1 part gravity 
cream to each 3 parts of whole milk to make the 
high fat percentage. 

High fat mixture may often be usefully employed, 
especially during the first six months of infancy; 
they are proportioned as follows : 





to 

<D 
U 

a 

a 
O 


V 

1 




en 

O 

O 


s 

<-> 




B 

O 


(A 

HI 

1 

O 


B 

i 





d 

O 


V 


d 

3 
O 


Top milk (7%) . . . 


2 


3 


4 


5 


6 


7 


8 


9 


IO 


Milk sugar 


1 


1 


1 


1 


1 


1 


1 


1 


I 


Lime-water 


' 


1 


1 


1 


1 


1 


1 


1 


I 


Water (boiled) 


*7 


16 


15 


14 


13 


12 


n 


10 


9 



The first three formulas are to be employed up 
to the third week of life; afterward the strength is 
slowly increased until the sixth or seventh month, 



2 33 



when it is better to change to a whole milk mixture. 
This is done by removing more and more of the 
upper milk; for example, take first 20 ounces and 
then 24 from the quart of milk and finally use the 
whole milk well stirred together. Thus: 



Milk, 4 or 5% 



Of upper Of upper 

20 ounces 24 ounces 

use use 

ounces n. ounces 12. 



Of whole 

milk use 

ounces 13. 



Milk sugar 


ounce 1. 


ounce 1. 


ounce 1. 






ounce 1. 














ounces 7. 











The third formula should be reached by the 
ninth month, and, beyond a gradual increase in 
quantity, needs but small change during the rest 
of the first year. 

Dr. Joseph E. Winters* employs a cream food 
during the first three weeks. Afterward he uses, 
for different ages, a specified quantity of the upper 
layer dipped from a quart of whole milk sixteen 
hours after milking, and modified by the addition 
of milk sugar, lime-water and filtered water. As 
this scheme of feeding has proved very successful 
I present it in the following table: 



♦"Feeding in Early Infancy, 
March 7, 1903. 



reprint from Medical Record, 






234 



HYGIENE OF THE NURSERY 

GENERAL FORMULAS. 



Age. 


Cream. 




Milk 
sugar. 


.5 dj 
.4* 


1 ai 

I 1 


Ii ■ 

<3 




ist and 2d days. . . 1 

oz. (a) 




3 1 tea- 
spoonfuls 


1* 

oz. 


9 


i 

oz. 


10 


d d 


oz.\b) 




3$ tea- ii 

spoonfuls 1 oz. 


9 

oz. 


oz. 


10 






4th to 7th day 


oz. (c) 


.... 


4 tea- 
spoonfuls 


oz. 


oz. 


I 


10 


2d week f 2 \ 

oz. (<i) 


.... 4 tea- | 2 
spoonfuls oz. 


10 j ii 
oz. i oz. 


10 




6 J 7 tea- 4 
oz. spoonfuls oz. 


18 

oz. 


2 

oz. 










9 8 tea- 1 4 
oz. spoonfuls oz. 


19 

oz. 


2* 

oz. 


10 








1 1 
oz. 


7-} tea- | 4 
spoonfuls 1 oz. 


17 

oz. 


3-4 
oz. 


8 








13 

oz. 


7 tea- 4 
spoonfuls 1 oz. 


15 

oz. 


3-4 

oz. 








5th and 6th months. 1 


15 61 tea- 4 
oz. j spoonfuls oz. 


13 

oz. 


5 
oz. 


7 


1 oz. ! spoonfuls oz. oz. 


5-6 
oz. 


6 


10th and 1 ith 

months. 


21 

oz. 


4J tea- 
spoonfuls 


4 
oz. 


7 
oz. 


6 
oz. 


5 




2S 

oz. 


2 J tea- 
spoonfuls 


4 
oz. 


3 
oz. 


6 
oz. 









(a) (£>) Dip upper \ ounce from each of tivo quart bottles of milk, 
sixteen hours standing. (c) Dip upper i ounce from each of three 
quart bottles of milk, sixteen hours standing, (d) (et seq.) Dip quantity 
from one quart bottle of milk, sixteen hours standing. 



Dr. Winters also suggests that the modifications 
employed during the hot months of summer should 
be distinctly different from those adapted for 



235 



general use in the cooler months, 
formulas are tabulated below: 



These weaker 



SUMMER FORMULAS. 



Age. 


Cream. 


p 

£3 


Milk 
sugar. 




•0 . 

J* 


51 


1& 

B in 
s £ 

5 




oz. (a) 






li 

oz. 


9 oz. 


oz. 






spoonfuls 




2d week 


oz. (6) 




4 tea- 
spoonfuls 


2 
OZ. 


ioi 

oz. 


oz. 


TO 






3d and 4th weeks. . 


2I 
oz. (c) 




4 tea- 
spoonfuls 


2 
OZ. 


10 
oz. 


2-2* 

oz. 


10 




6 
oz. 


7 tea- 
spoonfuls 


4 
OZ. 


18 

oz. 


2* 

oz. 


10 








7th week to end of 
3d month. 




9 
oz. 


8 tea- 
spoonfuls 


4 
oz. 


19 
oz. 


24-4 

oz. 


8 




II 
oz. 


7i tea- 
spoonfuls 


4 

oz. 


"7 
oz. 


4 
oz. 








5th and 6th months 




13 

oz. 


7 tea- 
spoonfuls 


4 

oz. 


15 

oz. 


s 

oz. 


7 






IS 


65 tea- 
spoonfuls 


4 
oz. 


13 

oz. 


5-6 
oz. 


6 








8th and 9th months 




17 
oz. 


si tea- 
spoonfuls 


4 
oz. 


II 
oz. 


5-6 
oz. 


6 



(a) Dip upper £ ounce from each of two quart bottles of milk, six- 
teen hours standing. (6) Dip upper i ounce from each of three quart 
bottles of milk, sixteen hours standing, (c) (el scq.) Dip quantity from 
one quart bottle of milk, sixteen hours standing. 

In the above the strengthening is more gradual than in the General 
Formulas. 



Dr. Henry Dwight Chapin also recommends top- 
milk feeding. He uses the purest obtainable milk, 
taken from a herd of cows and bottled and cooled 
as quickly as possible. Upon delivery such milk 



236 HYGIENE OF THE NURSERY 

shows a distinct layer of cream in the neck of the 
bottle. He writes: 

"For young infants, remove from the top of a 
quart bottle all the cream and enough milk to make 
nine ounces, and mix in a pitcher or bowl for dilu- 
tion. This is called nine-ounce top milk. (Fat to 
proteids, three to one). 

"For the older infants, remove from the top of a 
quart bottle all the cream and enough milk to make 
sixteen ounces (one pint) and mix in a pitcher or 
bowl for dilution. This is called sixteen-ounce top 
milk. (Fat to proteids, two to one). 

"For young infants, one part of the nine-ounce top 
milk should be mixed with three to eight parts of the 
diluent, and one part of sugar added to twenty to thirty 
parts of food; granulated or milk sugar may be used. 

"For older infants, one part of the sixteen-ounce 
top milk should be mixed with one to two parts of 
the diluent, and one part of sugar added to twenty 
to thirty parts of food; granulated or milk sugar 
may be used. 

"In every instance begin on a weak mixture and 
gradually decrease the dilution." 

The following table, given by Dr. Chapin, shows 
the simplicity of preparing food by his method, and 
indicates the quantities and dilutions ordinarily 
required. Each mixture can be prepared from 
one quart of milk: 



237 



PROGRESSIVE INCREASE OF QUANTITY AND STRENGTH OF 
MIXTURES. 



Sixteen ounces — one-eighth top 
milk. Eight 2-oz. feedings; one 
every two hours. 

Twenty-one ounces — one-seventh 
top milk. Eight i\ oz. feedings; 
one every two hours. 

Twenty-four ounces — one-s i x t h 
top milk. Eight 3-oz. feedings; 
one every two hours. 

Thirty ounces — one-fifth top milk. 
Seven 4-oz. feedings; one every 
two and one-half to three hours. 



Thirty-six ounces — one-fourth top 
milk. Six 6-oz. feedings; one 
every three hours. 

Forty-two ounces — one-third top 
milk. Six 7-oz. feedings; one 
every three hours. 

Forty ounces — one-half top milk. 
Six 7-oz. or five 8-oz. feedings; 
one every three to three and one- 
half hours. 

Forty-eight ounces — two-thirds 
top milk. Six 8-oz. or five 10- 
oz. feedings; one every three and 
one-half hours. 



2 oz. of 9-oz. top milk (after being 
removed from bottle and mixed). 

14 oz. diluted.* 
1 oz. sugar.f 

3 oz. of 9-oz. top milk (after being 

removed from bottle and mixed) . 
18 oz. diluent. 
1 oz. sugar. 

4 oz. of 9-oz. top milk (after being 
removed from bottle and mixed) . 

20 oz. diluent. 

1 oz. sugar. 

6 oz. of 9-oz. top milk (after being 
removed from bottle and mixed) . 

24 oz. diluent. 

ii oz. sugar. 

9 oz. top milk from one quart 
bottle. 

27 oz. diluent. 
ii oz. sugar. 

14 oz. top milk from one quart 
bottle. 

28 oz. diluent. 

2 oz. sugar. 

20 oz. top milk from one quart 

bottle. 
20 oz. diluent. 
1 oz. sugar. 

1 quart of milk. 
1 pint of diluent. 



* Diluent may be water, plain cereal gruel, or dextrinized gruel. 

f Two level tablespoonf uls of granulated sugar or three of milk 
sugar equal about one ounce; either may be used. 

To make cereal gruel, beat up one or two heaped tablespoon- 
fuls of barley, wheat, or rice flour, or double the quantity of 
rolled oats, with enough cold water to make a thin paste. Pour 
on a quart of boiling water, and boil (preferably in a covered double 
boiler) for at least fifteen minutes. 

To dextrinize, after cooking place the boiler in cold water and 
when the gruel is cool enough to be tasted without burning the 
tongue, add one teaspoonful of diastase solution and stir. When 
the gruel becomes thin, strain, add salt, and cool. 



238 HYGIENE OF THE NURSERY 

MILK AND WHITE-OF-EGG FOOD. 

The whites of three eggs. 

Lime-water 3 tablespoonfuls (fid. oz. i£). 

Milk 1 pint. 

Shake the egg and lime-water forcibly together 
for five minutes; then add the milk slowly with 
constant stirring, occupying ten minutes in the 
process; keep in a cool place. 

PEPTONIZED FOODS. 
For the process of peptonization, or predigestion, 
the extractum pancreatis, prepared by Fairchild 
Bros. & Foster, New York, gives, in my experience, 
the most satisfactory results, and in all the recipes 
given below this preparation is to be used. 

PEPTONIZED MILK, NO. 1. 

One peptonizing tube. 

Water 1 teacupful (fld. oz. 4). 

Milk, fresh and cold 1 pint. 

Put the powder contained in the tube into a clean 
quart bottle; add the cold water and shake well; 
then pour in the milk and shake the mixture thor- 
oughly again. Place the bottle in water of about 
1 1 5 F., or so hot that the whole hand can be held 
in it without discomfort for a minute, and keep the 
bottle there for ten minutes. Then put the bottle 
in contact with ice to check further digestion and 
to keep the milk from spoiling. 



DIETARY 239 

Peptonized milk should have a slightly, but not 
decidedly, bitter taste. It may be made palatable 
by serving with grated nutmeg, sugar, or a little 
brandy, or it may be taken with Apollinaris or 
Vichy water. In the latter case put the water first 
into the glass, then quickly pour in the peptonized 
milk and drink while effervescing. 

PEPTONIZED MILK, NO. 2. 

Mix the peptonizing powder, water and milk in 
a bottle, and place in a hot-water bath exactly as 
directed in the above. Let the bottle remain in the 
hot water for one hour, then pour into a saucepan 
and heal to boiling. This specially peptonized milk 
is used in making jellies, etc. It may be immedi- 
ately used if required hot, or set aside on ice for 
punches, etc. 

The object of raising the liquid to the boiling- 
point is to destroy the activity of the pancreatin, so 
that it may not act secondarily upon other sub- 
stances prepared with the milk. 

PARTIALLY PEPTONIZED MILK. 
Take the same ingredients mixed as before. 
Place the saucepan on a hot range or gas stove 
and heat with constant stirring until the mixture 
boils, being careful to so apply the heat that boiling 
will take place at the end of ten minutes. When 



240 HYGIENE OF THE NURSERY 

cool strain into a clean bottle; cork well, and keep 
in a cool place. When needed shake the bottle 
and serve the required portion cool or hot as desired. 
By this method peptonization is more advanced 
than by the next process, but the milk will not 
become bitter. 

PEPTONIZATION BY COLD PROCESS. 

Take the same ingredients and mix them as 
before, but immediately place the bottle on ice 
without subjecting it to any heat. 

This preparation is useful in cases of enfeebled 
digestive power, or as a means of returning from 
predigested milk to ordinary milk. It has no 
special taste. 

PEPTONIZED MILK GRUEL. 

One peptonizing tube. 

Wheat flour or arrowroot i heaping teaspoonful. 

Water, cold £ pint. 

Milk, cold i pint. 

Make a smooth mixture of the arrowroot and water; 
heat this with constant stirring until is has boiled 
briskly for three minutes; next add the milk; 
strain into a pitcher and stir in the peptonizing 
powder; let the mixture stand in the hot-water 
bath, 1 1 5 F., for thirty minutes; then pour into 
a clean bottle and place on ice. 



DIETARY 241 

PEPTONIZED BEEF TEA. 

To one-quarter of a pound of minced raw beef, 
entirely free from fat, add one-half pint of cold 
water; cook over a slow fire, with constant stirring, 
until it has boiled a few minutes; then pour off the 
liquor and beat or rub the meat to a paste; put the 
latter into a jar with one- half pint of cold water, 
and pour in the liquid previously obtained. Add to 
this mixture twenty grains of extract of pancreas 
and fifteen grains of bicarbonate of sodium; shake 
all well together, and keep at a temperature of 
about no to 150 F., stirring occasionally, for 
three hours. Next boil quickly, strain, and serve 
as required. 

PEPTONIZED OYSTERS. 
(Originally suggested by the late Dr. N. A. Randolph.) 

Take half a dozen large oysters with their juice 
and half a pint of water. Heat in a saucepan until 
they have boiled briskly for a few minutes. Pour 
off the broth and set aside. Mince the oysters fine 
in a wooden bowl, and reduce them to a paste with 
a potato masher. Next put the oysters in a glass 
jar with the broth which has been set aside, and 
add fifteen grains each of extract of pancreas and 
bicarbonate of sodium. Let the jar stand in hot 
water or in a warm place, where the temperature 
is not above 115 F., for one and one-half hours. 
16 



242 HYGIENE OF THE NURSERY 

Next pour into a saucepan and add half a pint of 
milk; heat over the fire slowly to boiling point, and 
flavor with salt to taste, and serve hot. 

HUMANIZED MILK. 

Peptogenic milk powder i level teaspoonful. 

Milk, fresh and cold 4 tablespoonfuls (fid. oz. 2). 

Water 4 tablespoonfuls (fid. oz. 2). 

Cream J tablespoonful (fid. oz. i). 

Heat cautiously over a flame, stirring constantly 
with a food thermometer* and being careful to 
observe that the temperature is maintained at about 
1 1 5 F. for full six minutes; never let the mixture 
boil. Then put into a nursing bottle, and cool to 
98 F., when it is ready for administering. The 
cup should be held by the hand over the flame, thus 
making it easy to regulate the heat to which the 
milk is exposed. 

It is important to follow out these directions abso- 
lutely, for should the temperature of the mixture 
not be maintained at a sufficiently high point, the 
pancreatin contained in the peptogenic powder 
will perform its work imperfectly; on the other 
hand, should the heat nearly approach the boiling- 
point all digestive activity will be suspended. 

* A bath thermometer taken out of its wooden frame makes a 
serviceable and sufficiently accurate instrument for observing 
temperature in food preparation. 



DIETARY 243 

Humanized milk so prepared is adapted to the 
average infant's digestion. As age advances, the 
proportion of milk may be increased to a proportion 
as high as 2 to 1 of water, and the total quantity of 
the mixture augmented. As an increase in quantity 
is made, it is necessary to preserve the relations of 
the peptogenic powder to the liquid; namely, one 
teaspoonful to each four ounces and a half. 

Sometimes it will be found' necessary to carry the 
process of predigestion further than can be accom- 
plished by following the directions already given. 
This may be readily done by increasing the length 
of the time of heating. One can thus easily produce 
in the milk any degree of change up to complete 
peptonization, when the liquid becomes clear and 
very bitter. Conversely, when it is desirable — in 
case of returning health, for instance — to resume 
a plain milk diet, the time of heating is gradually 
shortened until the powder is added to the milk 
mixture just at the time of feeding. When the time 
comes to abandon the digesting powder entirely it 
is most important to supply its place in the food by 
an equal bulk of milk sugar. 

The milk and cream referred to are of such qual- 
ity as can be obtained from a reliable city dealer; 
extra rich milk or cream may, under some circum- 
stances, require to be more diluted. If it be desired 
to prepare the whole day's food supply at one time, 



244 HYGIENE OF THE NURSERY 

the required quantity is heated in bulk to 115 F., 
kept at this temperature for ten minutes, with con- 
stant stirring, and then brought quickly to the 
boiling point (212 ) to destroy the activity of the 
pancreatin. Next it is poured into the feeding 
bottles, which, after being stopped with cotton, are 
placed in cold water to rapidly cool the mixture, 
and then in a refrigerator to await the feeding time 
when they are reheated to 98 F. 

MEAT BROTHS, Etc. 

BEEF BROTH. 

Lean beef with bone 1 pound. 

Cold water i quart. 

Salt 1 teaspoonful. 

Boiled rice or barley 2 tablespoonf uls. 

Remove fat from meat and cut into small pieces, 
put, with crushed bone, in a kettle, add water and 
let stand for half-an-hour. Heat slowly to boiling, 
skim and add salt. Simmer, without boiling, for 
four hours, remove fat and strain. At time of 
serving add rice or barley, previously well soaked 
and cooked. 

RAW-BEEF JUICE. 

Take one pound of sirloin of beef; warm it on a 
broiler before a quick fire; cut into cubes of about 
one-quarter of an inch, and after placing in a lemon 



DIETARY 245 

squeezer or meat press, forcibly express the juice; 
remove the fat that rises to the surface after cooling. 

This may be given warm or cold, and seasoned 
with a little salt, in doses of one teaspoonful every 
two hours to a child of six months to a year old. 

The meat must never be actually cooked and 
must be fresh and sound. 

RAW BEEF. 

Cut a tenderloin beefsteak into the finest possible 
pieces and free it as nearly as may be from particles 
of fat; then place in a mortar and pound until the 
meat becomes pulpy; next rub through a fine sieve 
and season with salt and a little black pepper. 

A teaspoonful of this pulp three or four times 
daily will be sufficient for a child one year old. 

CLEAR BROWN SOUP. 

Cut a shin of beef into pieces; put it into a sauce- 
pan with just enough water to cover it; when it 
boils, skim it, and add a bundle of sweet herbs, a 
little turnip, carrot, onion and celery, and a little 
pepper and salt. Let the whole boil until the meat 
is quite tender; then strain, and let it stand until 
the next day. After clearing it thoroughly from 
fat, heat it again, adding as much browning as will 
make the sou]) the color you like. Beat up two 
eggs, with their crushed shells, till they are quite 



246 HYGIENE OF THE NURSERY 

a froth. Put them into the soup with a whisk; let 
it boil gently for ten minutes; then strain it through 
a cloth, and it will be perfectly bright. — (Dr. Ellis.) 

consomme\ 

Make a beef broth by taking one or two pounds 
of beef, according to the strength required, from 
the leg, round or chuck; wash well; cut in pieces 
and put on to boil in three quarts of cold water, 
While boiling, skim frequently, and when reduced to 
one quart, take from the saucepan and strain; after 
which return to the saucepan with a few thin slices 
of onion, and half a pound of lean beef, chopped 
fine, and well mixed with three raw eggs; beat all 
thoroughly with the broth, which is to be returned 
to the fire and boiled for about half an hour, or 
until perfectly clear. 

CHICKEN BROTH. 

A small chicken, or half of a large fowl, thor- 
oughly cleaned, and with all the skin and fat re- 
moved, is to be chopped, bones and all, into small 
pieces; put these, with a proper quantity of salt, 
into a saucepan and add a quart of boiling water; 
cover closely and simmer over a slow fire for two 
hours; after removing, allow to stand, still covered, 
for an hour, and strain through a sieve. 



DIETARY 247 

MUTTON BROTH. 

Lean loin of mutton 1 pound (exclusive of bone). 

Water 3 pints. 

Boil gently until very tender, about four hours, add- 
ing a little salt; strain into a basin, and, when cold, 
skim off the fat. Warm in a double boiler, when 
served. 

Should barley or rice be added, they must be first 
separately and thoroughly soaked and boiled, and 
added when the broth is heated for use. 

VEAL BROTH. 

Lean veal i to 1 pound, according to 

strength required. 
Cold water 1 pint. 

Mince the meat; pour upon it a pint of cold water; 
let it stand for three hours; then slowly heat to 
boiling point, and after boiling briskly for two 
minutes, strain through a fine sieve and season 
with salt. 

• OYSTER SOUP. 

Drain one pint of oysters through a colander for 
five minutes, to remove the liquor, and then pour 
over them one pint of boiling water, which must be 
thrown aside; add to the liquor already drained a 
pint of boiling water and put over the fire in a porce- 



248 HYGIENE OF THE NURSERY 

Iain-lined saucepan. Boil until all the scum has 
risen and been skimmed off; then add half a pint 
of fresh milk, one water cracker rolled to a powder, 
a piece of butter, and a little salt and pepper; boil 
ten minutes, and just before the soup is to be served 
turn in the oysters from the colander and let them 
scald for three minutes. 

ARROWROOT PUDDING. 

Mix a tablespoonful of arrowroot with cold water; 
put it over the fire in a porcelain-lined saucepan; 
add a pint of boiling milk, stirring constantly, and 
one egg well beaten with a tablespoonful of white 
sugar; let it boil five or ten minutes. 

If baked pudding be preferred, it may be mixed 
in the same way and baked, in a moderately quick 
oven, for twenty or thirty minutes. 

BLANC MANGE. 

Gelatin \ ounce. 

Water £ pint. 

Cream 1 pint. 

White sugar 3 ounces. 

Extract of lemon Sufficient to flavor. 

Dissolve the gelatin in the water by means of heat, 
meanwhile whipping the cream and sugar together 
and adding the lemon. Next, while the gelatin 
solution is still warm, pour in the cream slowly, and 



DIETARY 249 

beat until stiff enough to drop from the spoon; finally 
pour in moulds. 

Milk may be used instead of water in this prepa- 
ration. 

HOMINY GRITS. 

Two tablespoonfuls of hominy, having been 
thoroughly soaked and boiled soft, are rubbed up 
with butter until quite light; then, half a pint of 
boiled milk is added slowly, with constant stirring; 
next strain through a sieve and boil again; flavor 
with sugar or salt, and serve hot. Rice may be 
prepared in the same way. 

JUNKET. 

Milk 1 pint. 

Essence of pepsin (Fairchild's) 2 teaspoonfuls. 

(Wine of pepsin or liquid rennet may also be used.) 

Heat the milk to a temperature of ioo° F. (luke- 
warm), and add, with gentle stirring, the curdling 
agent; allow to stand until firmly curded, and serve 
with sugar, nutmeg, or cream as desired. 

JUNKET WITH EGG. 

A good custard may be made by adding two 

eggs, beaten to a froth and sweetened with four 

teaspoonfuls of sugar to the pint of milk, and then 

curdling with essence of pepsin. It is well to pour 



250 HYGIENE OF THE NURSERY 

this, when prepared, into coffee cups, one of which 
will be enough to serve at a time. 

MILK AND GELATIN. 

Gelatin 1 tablespoonful. 

Barley water, hot | pint. 

Powdered sugar 2 tablespoonf uls. 

Milk 1 pint. 

Dissolve the gelatin in the hot barley water; add the 
sugar, and then the milk, stirring all together. 

RICE MILK. 

Rice 2 tablespoonfuls. 

Cornstarch 1 teaspoonful. 

Milk 2 pints. 

Boil in a farina boiler until each grain of the rice 
becomes saturated, and the whole creamy in color. 

RICE PUDDING. 
Take three ounces of rice, and swell it very gently 
in one pint of new milk. Let it cool; then stir into 
it one ounce of fresh butter, two ounces of pounded 
sugar, the yolks of three eggs, and some grated 
lemon rind. Pour this into a well-buttered dish, 
but do not quite fill it, and then lay lightly over 
the top the whites of three eggs which have been 
well beaten up with three tablespoonfuls of sifted 
sugar. Put the pudding directly into the oven, the 
heat of which must be moderate, and bake it for 



DIETARY 251 

about twenty minutes, or till the egg crust has 
become lightly browned. 

OATMEAL GRUEL. 

Mix a large tablespoonful of oatmeal flour with 
two tablespoonfuls of cold water, stirring to bring 
to a state of uniformity; pour this into a pint of 
boiling water in a double boiler, and boil for twenty 
minutes. Strain and flavor with salt or sugar. 

SAGO JELLY. 

Take two tablespoonfuls of sago; wash carefully; 
soak for four hours in half a pint of cold water, and 
then add half a pint of hot water, a pinch of salt, a 
tablespoonful of sugar and a little grated lemon 
peel; boil gently fifteen minutes, stirring constantly. 
A little port wine or sherry may be added just 
before removing from the fire. May be served hot 
or cold. 

TAPIOCA. 

Wash two tablespoonfuls of the best tapioca; 
soak in fresh water over night; add a little salt, a 
pint of milk or water, and simmer until quite soft, 
stirring frequently if milk be used; then pour into 
bowl and stir while cooling, at the same time 
adding sugar, some flavoring substance, and wine 
if desired. 






252 HYGIENE OF THE NURSERY 

TAPIOCA PUDDING. 

Beat the yolks of two eggs with half an ounce of 
sugar; stir into a pint of tapioca mucilage made with 
milk, as directed above, and bake in a slow oven. 

EGG AND BRANDY. 

Brandy 8 tablespoonfuls (fid. oz. 4). 

Cinnamon water 8 tablespoonfuls (fid. oz. 4). 

The yolks of two eggs. 

White sugar 1 tablespoonful. 

Rub the yolks and sugar together; then add the 
cinnamon-water and spirit. A dessertspoonful to 
two tablespoonfuls may be given every two hours, 
according to the age of the child. 

WINE WHEY. 

Boil a pint of fresh milk; while boiling, pour in 
eight tablespoonfuls of sherry wine; bring it to the 
boil a second time, being careful not to stir it; when 
it boils, put it aside until the curd settles, and pour 
off the clear whey. 

FLAX-SEED TEA. 

Whole flaxseed 1 ounce. 

Bruised licorice root 2 teaspoonfuls. 

Water, boiling 1 pint. 

Pour the boiling water over the flax-seed and lico- 
rice; cover lightly; digest for three hours near a 



DIETARY 253 

fire, and strain. Two tablespoonfuls of lemon juice 
may be used as the flavor instead of licorice. 

The following preparations are useful as additions 
to milk in bottle-feeding: 

ALBUMIN-WATER. 

Mix, by thoroughly shaking, the raw whites of one 
or two fresh eggs with one pint of cold, pure water. 
Sugar or salt may be added to taste. 

BARLEY-WATER. 

Put two teaspoonfuls of washed pearl barley into 
a saucepan with a pint of clear water, and boil 
slowly down to two- thirds of a pint; strain through 
muslin. Or blend carefully one or two teaspoon- 
fuls, according to the thickness required, of barley 
flour with an equal quantity of cold water, add 
gradually to one pint of boiling water and boil 
gently for twenty minutes; strain. 

OATMEAL- OR CRACKED-WHEAT WATER. 

Add from 1 to 3 tablespoonfuls of well-cooked 
oatmeal or cracked-wheat porridge to a pint of 
water; heat almost to boiling-point with constant 
stirring until a smooth mixture is obtained; strain. 

RICE-WATER. 
Put two tablespoonfuls of rice, thoroughly washed, 
into a quart of water and place near the fire, where 
it may soak and be kept warm for two hours; then 



254 HYGIENE OF THE NURSERY 

boil slowly for one hour, or until the water is re- 
duced one-half, and strain. Useful as a diluent for 
milk in cases of diarrhoea. 

Rice-water may be made from the powdered 
grain in the same way as barley-water. 

LIME-WATER. 

Take one heaping teaspoonful of slaked lime and 
put with one quart of boiled or distilled water into 
a bottle, well corked, and shake thoroughly two or 
three times at intervals of half an hour; then allow 
to settle and after twenty-four hours siphon off, for 
use, the upper clear fluid; this should be put in a 
perfectly clean bottle which must be kept securely 
stopped. 

WHEY. 

Milk i pint. 

Essence of pepsin (Fairchild's) 2 teaspoonfuls. 

Heat the milk to a temperature of ioo° F., and add 
the pepsin with gentle stirring; let the whole stand 
until firm coagulation has taken place; then beat 
with a fork until the curd is finely divided, and 
strain. 

If the whey is to be used with cream in feeding, 
it should, after being strained, be reheated to a 
temperature of 160 F. and so kept with constant 
stirring for three minutes. The object of this is 



DIETARY 255 

to check the curdling activity of the excess of pepsin, 
so that when the cream is added there may be no 
precipitation of its casein and the formation of a 
curdy mixture. 

GELATIN. 

Put a piece of plate gelatin, an inch square, into 
half a tumblerful of cold water, and let it stand for 
three hours; then turn the whole into a teacup, 
place this in a saucepan half full of water, and boil 
until the gelatin is dissolved. When cold, this 
forms into jelly. From one to two teaspoonfuls 
may be added to each bottle of milk food. Em- 
ployed as an attenuant. 

FLOUR-BALL. 

Take a pound of good wheat flour — unbolted, if 
possible; tie it up very tightly in a strong pudding- 
bag; place it in a saucepan of water and boil con- 
stantly for ten hours; when cold remove the cloth; 
cut away the soft outer covering of dough that has 
been formed, and reduce the hard, baked interior 
by grating. 

In the yellowish-white powder obtained, almost 
all the starch has been converted into dextrin by 
the process of cooking, and the proportion of the 
nitrogenous principle to the calorifacient is as one 
to five — nearly the same as in human milk. 

This acts both mechanically and as a food. 



256 



HYGIENE OF THE NURSERY 



PEARL-BARLEY JELLY. 

Put three tablespoonfuls of pearl barley soaked 
over night into a double boiler with a quart of 
clear water and boil slowly down to a pint; strain, 
and allow the liquid to set into a jelly. In making 
this jelly from barley flour, thoroughly mix one 
tablespoonful of this flour with two tablespoonfuls 
of cold water, add gradually to four ounces of boil- 
ing water and boil for twenty 
minutes; strain. 

Used for same purpose as 
barley water. 

NUTRITIOUS ENEMATA. 

The process of peptonization, 
already described, is very useful 
in the preparation of food for 
absorption by the lining mem- 
brane of the rectum. Peptonized 
milk No. 1, or an egg mixed with 
a pint of milk and thoroughly 
peptonized, is the best food for 
employment in this way, the 
only caution being to administer 
in small quantities— from four to eight tablespoon- 
fuls according to age — and at intervals of not 
less than four hours. The injection should be 
made gently and slowly and the liquid should be 




Fig. 23. — Syringe for 

Nutritious Enemata. 



DIETARY 257 

warmed to a temperature of 98 F. It is essen- 
tial, too, in rectal feeding to keep the lower bowel 
clear by a daily irrigation of warm (98 F.) normal 
saline solution (1 teaspoonful of salt to 1 pint of 
boiled water). 

The best syringe for the operation is shown in 
Fig. 23. 

DIET IN SPECIAL DISEASES. 

In formulating the following diet lists it is neces- 
sary to adapt them to definite ages, but, provided 
the essential idea is adhered to, the quantity of the 
food may be increased or diminished and the 
quality altered to suit the age of the special patient. 

PARTIAL PEPTONIZATION FOR FEEBLE DIGESTION 
—AGE, FOUR MONTHS. 

Make each bottle of food as follows: 

Cream 1 tablespoonful (flcl. oz. J). 

Milk 5 tablespoonfuls (fid. oz. 2^). 

Water 4 tablespoonfuls (fid. oz. 2 ). 

Peptogenic milk powder.. . . i level teaspoonful. 

After mixing, heat cautiously over a flame for six minutes, 
stirring constantly with a food thermometer, being very careful 
that the temperature of the mixture is maintained between 115 
and 120 F. Do not boil. Cool to 98 F. before administering. 

Feed every two and one-half hours from 6 A.M. to 10 P.M. 

In case each bottle cannot be prepared separately — by far the 
better way — the whole quantity for each day may be prepared in 
the morning as follows: 
17 



258 HYGIENE OF THE NURSERY 

Cream 8 tablespoonfuls (fld. oz. 4). 

Milk 40 tablespoonfuls (fld. oz. 20). 

Water 32 tablespoonfuls (fld. oz. 16). 

Peptogenic milk powder 8 level teaspoonfuls. 

Heat slowly, so as to bring to a full boil at the end of ten 
minutes; fill eight graduated nursing bottles to the 5-oz. mark, 
cork with cotton, and place in nursery refrigerator; heat to 98 
F. at time of administration. 

To return to unpeptonized diet, gradually reduce the time of 
heating, and finally replace the milk powder by sugar of milk and 
salt. 

A mixture stronger than 2 parts of milk to 1 part of water is 
difficult to predigest without curdling, especially if the milk be of 
more than ordinarily good quality. 

"NO-MILK" DIET FOR ACUTE GASTRO-INTESTINAL 
DISORDERS— ACUTE VOMITING, ENTERO-CO- 
LITIS, CHOLERIFORM DIARRH(EA, ETC.— AGE, 
SIX MONTHS. 

1. 

Whey 4 tablespoonfuls (fld. oz. 2). 

Barley-water 4 tablespoonfuls (fld. oz. 2). 

Milk sugar 1 teaspoonful. 

For one portion, to be given every two hours. 
2. 

Flour- ball or barley- jelly . 1 teaspoonful. 

Water 8 tablespoonfuls (fld. oz. 4). 

Mix and add half the white of a fresh egg. 

For one portion, to be given every two hours. 

3- 

Veal-broth (^ lb. of meat to a pint of water), 

Barley-water of each, 4 tablespoonfuls (fld. oz. 2). 

For one portion, to be given ever}' two hours. 
4- 

Raw-beef juice 1-2 teaspoonfuls (fld. dr. 1-2). 

Every two hours. 






DIETARY 259 

■\Yhile on Xo. 4 the patient must take from 12 to 24 fluidounces 
of pure water, barley-water, or white-of-egg water each twenty- 
four hours: to be given in small doses at short intervals. 

Resume milk feeding gradually after using any of these diets. 
Partially peptonized milk food is the best intermediate diet. 

DIET FOR CHRONIC GASTRO-INTESTINAL 

CATARRH— MUCOUS DISEASE OF 

OLDER CHILDREN. 

Breakfast, 7.30 A.M. — One or two tumblerfuls (fld. oz. 8) of milk 
guarded by lime-water (fid. oz. 2 to tumblerful), the yolk of a 
soft-boiled egg, and a thin slice of stale unbuttered bread. 

Luncheon, 11 a.m. — A cup (fld. oz. 4) of beef-, chicken-, or mutton- 
broth, entirely free from fat, and a thin slice of dry toast. 

Dinner, 2.30 p.m. — Broiled mutton-chops entirely free from fat 
(one or two, according to size), a large spoonful of well-boiled 
spinach, and a slice of stale dry bread. 

Supper, 7 p.m. — One or two tumblerfuls of milk guarded by lime- 
water, and a slice of dry toast. 
For drink, pure water or Vichy. 

Articles permissible for variety. — Beef, poultry, game, fresh fish, 
raw oysters, cauliflower-tops, asparagus, lettuce, celery, turnips, 
onions, carrots. 

Articles to be avoided. — All farinaceous substances, except stale 
or toasted bread (wheat or bran) ; even this must be restricted 
in quantity; potatoes, peas, beans, parsnips, fruit-cake, pastry, 
sweetmeats, and butter; tea, coffee, beer, wine, and all condi- 
ments except salt. 
If there be great debility, small doses of whiskey well diluted 

may be allowed. Keep skin active by bathing, frictions, inunc- 
tions with good olive oil, and warm clothing. 

DIET FOR CHRONIC VOMITING IN INFANTS. 

Fresh cream 1 tablespoonful (lid. oz. i). 

Whey 2 tablespoonfuls (fld. oz. 1). 

Barley-water.. 2 tablespoonfuls (fld. oz. 1). 



260 HYGIENE OF THE NURSERY 

Or, 

Weak veal-broth (^ lb. of veal to a pint of water). 
Thin barley-water equal quantities. 

Either food is best given cold, in small quantities and at short 
intervals — i.e., one teaspoonful every fifteen minutes in bad cases. 
As improvement begins, increase both quantity and intervals, but 
continue to feed with a spoon. After the stomach has been re- 
tentive for forty-eight hours, gradually return to bottle-feeding. 

Milk food must be very dilute, and partially predigested at 
first. 

In extreme cases No. 4 No-milk Diet (p. 258) may be required 
for a time. 

DIET FOR CHRONIC DIARRHCEA WHEN MILK FOODS 

UNDERGO ACID FERMENTATION— AGE 

SIX TO TWELVE MONTHS. 

First meal, 7 A.M. 

Veal-broth (£ lb. of veal to a pint of water), 
Barley-water ... of each, 6-8 tablespoonfuls (fid. oz. 3-4). 
Second meal, 10 A.M. 

Cream 1 tablespoonful (fid. oz. £). 

Whey (freshly prepared) .... 12 tablespoonfuls (fid. oz. 6). 
Third meal, 1 P.M. 

Same as first, with chicken-broth in place of veal-broth. 
Fourth meal, 5 p.m. 
Same as second. 
Fifth meal, 10 p.m. 
Same as first. 

If feeble, one meal at 4 a.m., same as second. 
In extreme cases No. 4 No- milk Diet (page 258) may be 
required temporarily, with twice each day — 
The yolk of a raw egg, 
Ten (10) drops of brandy, 
One (1) teaspoonful cinnamon-water, and 
One (1) coffeespoonful white sugar, 
Well beaten up. 



DIETARY 26l 

Partial peptonization is an important intermediary in resuming 
ordinary milk feeding. 

Older children require the diet for chronic gastro-intestinal 
catarrh. 

DIET FOR HABITUAL CONSTIPATION IN INFANTS- 
AGE, THREE MONTHS. 
1. 

Cream 1 tablespoonful (fid. oz. £). 

Milk 4 tablespoonfuls (fid. oz. 2). 

Milk sugar 1 teaspoonful (dram 1). 

Salt a pinch. 

Bethlehem oatmeal (fine 

powder) 2 teaspoonfuls (drams 2 ) . 

Water 3 tablespoonfuls (fid. oz. i£). 

Heat water almost to boiling-point; add the oatmeal slowly with 
stirring until a smooth mixture is obtained and boil in a double 
boiler for twenty minutes; then add the other ingredients. 

One or two such feedings each day will usually be sufficient, 
but the oatmeal may be added to each bottle if necessary. 
2. 

Cream 1 tablespoonful (fid. oz. £). 

Milk 4 tablespoonfuls (fid. oz. 2 ). 

Milk sugar 1 teaspoonful (dram 1 ) . 

Phosphate of sodium 2 grains. 

Wheat-water 3 tablespoonfuls (fid. oz. i£). 

To make wheat-water, add to 1 pint of water 1 or 2 tablespoon- 
fuls (according to effect desired) of thoroughly cooked cracked- 
wheat porridge; heat a little short of the boiling-point, stir con- 
stantly until a mixture is obtained, and strain. 

Dissolve phosphate of sodium in a teaspoonful of hot water, 
and add to food just before administration. May be used in one 
or more feedings as required. 

One or two teaspoonfuls of fresh, sweet orange juice midway 
between the second and third feeding. 
Encourage infant to take water. 



262 HYGIENE OF THE NURSERY 

Massage of abdomen with warm olive oil, over and in the course 
of the colon, twice daily, is of much service. 

DIET FOR HABITUAL CONSTIPATION IN OLDER 
CHILDREN— AGE, EIGHTEEN MONTHS TO 
TWO AND ONE-HALF YEARS. 

First meal, 7 a.m. — A breakfast-cupful (fid. oz. 8) of new milk, 
with an additional tablespoonful (fld. oz. \) of cream; 2 to 4 
tablespoonfuls of thoroughly cooked oatmeal or cracked-wheat 
porridge, with cream and salt ; two slices of whole wheat or bran 
bread buttered. One hour before breakfast the juice of a ripe 
orange, or half of a moderate sized ripe apple scraped with a 
spoon, or a small ripe pear, scraped, or a peach. 

Second meal, 11 a.m. — A teacupful (fid. oz. 6) of milk, with an 
additional tablespoonful (fid. oz. \) of cream; a slice of bran 
bread. 

Third meal, 2 p.m. — A breakfast-cupful (fid. oz. 8) of mutton- or 
chicken-broth, or 1 or 2 tablespoonfuls of underdone roast 
mutton, or beef, or chicken minced fine and pounded to a paste; 
puree of spinach; mashed cauliflower-tops; asparagus-tops; 
stewed celery; whole wheat or bran bread, buttered; junket 
and cream; rice-and-milk pudding with stewed prune juice; 
baked apple with cream. 

Fourth meal, 6.30 p.m. — Milk, one or two breakfast-cupf uls ; 
whole wheat or bran bread, buttered; stewed fruit. 
For drink, pure water only. No condiment but salt. 
Avoid farinaceous foods, sugar, candy, cake and pastry. 
Massage of abdomen with warm olive oil, over and in the 

course of the colon, twice daily, is of much service. 

DIET IN INFANTILE SCURVY— AGE, EIGHT MONTHS. 

First meal, 7 A.M. 

Cream 1 tablespoonful (fid. oz. \). 

Milk 9 tablespoonfuls (fld. oz. 4^). 

Milk sugar 1 teaspoonful (dram 1 ). 

Salt a pinch. 

Water 6 tablespoonfuls (fld. oz. 3 ). 



DIETARY 263 

At 9 a.m., one to two teaspoonfuls of fresh orange juice, 
according to effect on bowels. 
Second meal, 10.30 a.m., same as first. 

At 11.30 a.m. — Two teaspoonfuls of fresh raw-beef juice, free 

from fat, and with a little salt. 
At 1 p.m. — One to two teaspoonfuls of fresh orange juice. 
Third meal, 2 p.m., same as first. 
At 3 p.m. — Two teaspoonfuls of fresh raw-beef juice with salt. 
At 5 p.m. — One to two teaspoonfuls of fresh orange juice. 
Fourth meal, 6 p.m., same as first. 

At 8 P.M. — Two teaspoonfuls of fresh raw-beef juice with salt. 
Fifth meal, 10 P.M., same as first. 

Milk may be pasteurized or predigested if absolutely necessary, 
but never sterilized, for use in scurvy. Avoid all infant foods. 



DIET IN ACUTE NEPHRITIS, SCARLATINAL OR 
CATARRHAL— AGE, FOUR YEARS. 

First meal, 7.30 A.M. 

Milk 4 tablespoonfuls (fid. oz. 2 ). 

A good malt food 1 tablespoonful (oz. \). 

Barley-water n tablespoonfuls (fid. oz. 5^). 

Second meal, 10.30 a.m. — A teacupful (fid. oz. 6) of whey. 
Third meal, 1.30 p.m. — A teacupful (fid. oz. 6) of veal-broth 
(i lb. of veal to a pint of water), mutton- broth (\ lb. of 
mutton to a pint of water), or chicken-broth; 4 to 8 table- 
spoonfuls of a light farinaceous pudding. 
Fourth meal, 4.30 p.m. — Same as second. 
Fifth meal, 7 p.m. — Same as first. 
Sixth meal, 10 p.m. — Same as second. 

One or two whey feedings may be given during the night if 
required. 

Allow plenty of pure water — Poland water. 

In order to spare the kidneys, avoid food having much nitrogen- 



264 HYGIENE OF THE NURSERY 

DIET IN LITH^MIA, EXCESS OF URIC ACID IN URINE, 
GOUTY ECZEMA, ETC.— AGE, FOUR YEARS. 

First meal, 8 a.m. — Milk, 7 fluidounces, Vichy water, 1 fluid- 
ounce (one or two portions); one or two yolks of soft-boiled 
eggs with salt, or a bit of fresh fish or sweetbread; or one or 
two slices of bran or whole wheat bread, dry. 

Second meal, 1.30 p.m. — A teacupful of clear meat-broth; a piece 
of chicken, turkey, wild fowl, or fish; one well-cooked green 
vegetable — i. e., spinach, celery, young onions, cauliflower; 
one or two slices of dry bran or whole wheat bread; junket or 
rice-and-milk pudding. 

Third meal, 6.30 p.m. — Milk as at first meal; sweetbread or milk- 
toast; dry bran or whole wheat bread. 

For drink, Poland water or Vichy (domestic) ; use either freely. 
Avoid fats, starches, sweets, and red meats — i. e., beef or 

mutton. 

Exercise in fresh air is important. 



DIET IN RICKETS WITHOUT DIARRHOEA— AGE, 
EIGHTEEN MONTHS. 

(If diarrhoea be a symptom, use diet for chronic diarrhoea.) 
First meal, 7.30 A.M. — A breakfast-cupful (fld. oz. 8) of milk, 
with a tablespoonful (fld. oz. h) of cream; on alternate days 
the yolk of a soft-boiled egg, with a little butter, salt, and bread 
crumbs, and two tablespoonfuls of well-cooked and strained 
cracked-wheat porridge with cream and salt. 
Second meal, n a.m. — A breakfast-cupful (fld. oz. 8) of milk, 
with a tablespoonful (fld. oz. J) of cream and a slice of whole 
wheat bread. 
Third meal, 2 p.m. — A good tablespoonful of well-minced and 
pounded mutton or chicken, with gravy and a little crumbled 
stale bread; a tablespoonful of puree of spinach, or stewed 
celery or asparagus tops, or cauliflower tops; thin bread and 
butter. 



DIETARY 265 

Fourth meal, 6 p.m. — Milk and cream as at first and second meals; 
thin bread and butter. 
Drink pure water and avoid excess of farinaceous food. 

DIET IN PULMONARY PHTHISIS— AGE, SEVEN YEARS. 

First meal, 8 a.m. — A breakfast-cupful (fid. oz. 8) of milk, alkalin- 
ized with gr. v sodii bicarb.; a soft-boiled egg, or broiled fresh 
fish, or stewed sweetbread; thin bread, buttered. 

Second meal, n a.m. — Raw or stewed oysters, or a teacupful of 
meat-, oyster-, or clam-broth; thin bread, buttered. 

Third meal, 2.30 p.m. — A slice of roast beef, or mutton, with 
gravy, or of poultry or game; a mealy potato, mashed, or well- 
cooked rice; light farinaceous pudding made with milk; bread 
and butter; one to two tablespoonfuls (fid. oz. |-i) of a good 
dry sherry well diluted with water. 

Fourth meal, 6.30 P.M. — A breakfast-cupful (fid. oz. 8) of chocolate 
or cocoa; milk-toast; stewed oysters or sweetbread; bread and 
butter. 
Farinaceous food and all fat-forming material are indicated, but 

caution in administration is necessary on account of associated 

tendency to dyspepsia with acid fermentation. 

DIET AND REGIMEN IN CHOREA— CHILDHOOD. 

Confine patient to bed, and keep in recumbent position. 

At 5.30 A.M., a breakfast-cupful (fid. oz. 8) of warm milk. 

At 7 a.m., a breakfast-cupful (fid. oz. 8) of warm milk; three 

slices (1 oz. each) of bread, buttered. 
At 9 A.M., 2 to 4 tablespoonfuls (fid. oz. 1-2) of a good liquid 

extract of malt; or 1 tablespoonful of Merck's dry malt 

made into a sandwich with bread and butter. 
At 10 a.m., massage for fifteen minutes; afterwards give a 

teacupful (fid. oz. 6) of warm milk. 
At 12.30 p.m., dinner of well-cooked fresh vegetables; bread; 

a breakfast-cupful (fid. oz. 8) of milk; rice or other light 

pudding. 



266 HYGIENE OF THE NURSERY 

At 4.15 p.m., same as 7 a.m., with a soft-boiled egg. 

At 7 p.m., extract of malt as at 9 a.m. 

At 7.30 p.m., massage; afterwards give a teacupful (fid. oz 6) 
of warm milk. 

At the end of two weeks increase the amount of bread to four 
slices, add a lamb chop or a piece of chicken to the dinner (12.30 
p.m.), and increase portions of milk so that an extra pint is taken 
during the day. Allow the patient to sit up in bed and have toys 
to play with. Massage to be increased to half an hour each time. 

Never hurry the patient out of bed, especially in severe cases. 



CHAPTER X. 

MASSAGE. 

Systematic manipulation is of great value both as 
a means of preserving health and as a scientific 
method of treating certain diseases in children. 

Mere rubbing or friction of the surface cannot be 
included under massage in its literal sense; still, it 
is a useful form of manipulation, and needs no 
special instruction, being possible to any intelli- 
gent, soft-handed mother or nurse. 

Massage, on the contrary, is an art, and, like 
every other art, requires study and patient prepara- 
tion for its successful practice. It is a powerful 
remedy, too, and, like other agents of its class, as 
potent for evil as for good in unskilled hands. 
Therefore, to insure good results, a trained masseuse 
is necessary, and she must act under the direction 
of the physician. 

Massage includes several processes of manipula- 
tion. Those given by Murrell, from whose excel- 
lent little work* I have taken much of the descrip- 
tion of the different "movements," are effleurage, 
petrissage, friction, and tapotement. 

* "Massage as a Mode of Treatment." W. Murrell. 
267 



268 HYGIENE OF THE NURSERY 

Effleurage is a stroking movement made with the 
palm of the hand passing with more or less force 
over the surface of the body centripetally. The 
movements are made to follow as nearly as possible 
the direction of the muscle fibers, and for deep- 
seated tissues the knuckles can be used instead of 
the palm. This method is of minor value in itself, 
but of great use when combined, as is the rule, with 
the procedures to be described. 

Petrissage consists essentially in picking up a 
portion of muscle or other tissue with both hands 
or the fingers of one hand, and subjecting it to firm 
pressure, at the same time rolling it between the 
fingers and the subjacent tissues. The hands must 
move simultaneously and in opposite directions, the 
skin must move with the hands to avoid giving 
pain, and the thumb and fingers must be kept 
wide apart in order to grasp a bulk of tissue, a 
whole muscle belly, for instance. The manipulation 
must be uniform, in a direction from the extremities 
toward the centre of the body, bearing in mind the 
arrangement of groups of superficial muscles and 
keeping well in the spaces between them. 

Friction, or massage a frictions, is performed 
with the tips of the fingers. It is a pressure move- 
ment rather than a rubbing. It is always associated 
with effleurage, and, to be of any use, must be per- 
formed quickly and readily. 



MASSAGE 269 

Tapotement is a percussion which may be made 
with the tips of the fingers, their palmar surfaces, 
the palm of the hand, the back of the half-closed 
hand, one or other border of the hand, or with 
the hand partly closed, so as to contain, when 
brought in contact with the surface of the body, 
a cushion of air. 

The hand of the masseuse must be perfectly clean 
and soft, and the finger-nails short and smooth. 
The length and frequency of the sittings must vary 
with the individual case. Most authorities are in 
favor of short and frequent seances, and except in 
special cases recommend dry massage, that is, 
without the use of oil, liniments or ointments; 
vaseline especially is to be avoided. 

Clinical experience shows that massage increases 
the activity of the circulation, reddens the skin, and 
elevates the temperature in the part manipulated. 
It also increases the electrical contractility of mus- 
cular tissue, and stimulates the flow of lymph 
in the lymphatic vessels. Muscular stiffness and 
fatigue are relieved, nervous irritability is calmed, 
and restless and wakeful patients are soothed by it 
into refreshing sleep. 

With these facts at hand, it is not difficult to see 
what a useful agency we possess in skilfully em- 
ployed massage. By its application we have the 
power to prevent the wasting of muscles and to 



270 HYGIENE OF THE NURSERY 

augment muscle strength, to build up such tissues 
as fat and blood, to improve nerve force, both 
directly by producing a better blood supply and 
indirectly by relieving irritability and giving rest 
and sleep; and finally, to hasten the absorption of 
waste tissue and of morbid effusions. At the same 
time it must always be remembered that massage 
is a powerful remedy. A short seance with gentle 
movements may do good in infantile palsy, for ex- 
ample, but it does not follow that by doubling the 
time or force, twice as much benefit will be derived. 
In fact, the reverse of the proposition is true; short, 
gentle massage maintains the size and strength of 
the muscles, while long, forcible manipulation 
causes them to waste quickly. The same truth 
runs through the whole question and must be 
observed. 

Before entering upon the therapeutic application 
of massage proper, it will be well to revert to the 
process of simple rubbing, already mentioned. 
This is of much value as a general hygienic measure. 
Each day, after the bath, the skin having been thor- 
oughly dried by a soft, warm towel, the whole surface 
should be gently rubbed with the palm of the hand, 
the process occupying about five minutes. This 
increases the circulation in the minute blood-vessels, 
encouraging thorough reaction, aids nutrition and 
adds vigor to the frame. Weakly children especi- 



MASSAGE 271 

ally thrive under it. In older children, friction with 
a soft towel may be substituted for hand-rubbing, 
but this change should not be made before the fifth 
or sixth year. 

Sometimes it is well to rub certain portions of the 
body more thoroughly than others. Thus in rickets 
the spine should receive special attention, in indi- 
gestion and constipation, the abdomen; in weak 
ankles, the feet and legs, etc.; although even in 
these cases the general surface must receive a share. 

Massage may be employed with advantage in the 
following diseases of childhood: 

(a) Long-standing stomach or intestinal indiges- 
tion (chronic gastro-intestinal catarrh). In this 
condition the skin is harsh, and often so dry that 
a shower of dead scales falls from the surface on 
the removal of the underclothing; the muscle tone 
is faulty; general nutrition is impaired, and there is 
a determination of blood from the surface toward 
the mucous membranes. To get the skin active, 
and in this way balance the circulation, is an im- 
portant step in the reestablishment of normal diges- 
tion, secretion and excretion, the essentials of per- 
fect nutrition. To accomplish this, a full, warm 
bath is administered every evening, just before 
bedtime, the patient remaining in the water for five 
minutes. Then the surface is thoroughly dried, and 
half an ounce of olive oil is gently rubbed into the 



272 HYGIENE OF THE NURSERY 

skin (inunction), the child enveloped in a light 
blanket and put to bed. After a little time sweat- 
ing begins. As soon as the sweating is free the 
skin is again dried and the night-dress put on in 
preparation for sleep. Next morning, at some 
convenient time after breakfast, the child is sub- 
jected to twenty minutes' massage. The inunctions 
are continued until the skin becomes soft and active, 
and massage is employed daily until there is a de- 
cided improvement in the amount of flesh and 
general strength — a period generally of two or three 
weeks. Afterward, "movements" every third day 
will be sufficient to complete the cure. 

In these cases massage not only aids the baths 
and inunctions in their general action, but directly 
and powerfully increases nutrition and muscle force, 
and materially hastens an otherwise slow process of 
recovery. 

(b) Constipation. Manipulation is a very effi- 
cient remedy in habitual constipation, and there 
are many cases that can be cured by it, combined 
with a properly regulated diet, without the use of 
drugs. Petrissage of the large intestine is the best 
method, instructions being given to follow the natu- 
ral course of the faeces through this portion of the 
gut; thus, beginning in the right groin to proceed 
upward to the lower border of the ribs on the right 
side, to cross over, horizontally, to the same region 



MASSAGE 273 

on the left side, and then downward to the left groin. 
In this way the ascending transverse and descending 
colon are manipulated in order. 

Five or ten minutes every morning, or every 
morning and evening in obstinate cases, constitute 
the proper duration and frequency of the manifesta- 
tions. The pressure must be gentle, as delicate 
underlying tissues are being dealt with. 

In this condition I have not found the dry method 
so efficient as a combination of massage with the 
inunction of warm olive oil. 

Sometimes tapotement with the flat hand, with the 
hand partly closed forming a cushion, or with the 
margin of the hand, is necessary, but the course of 
the colon must always be followed. The beneficial 
action of this mode of treatment is, undoubtedly, 
threefold; it increases the intestinal and other se- 
cretions; it increases the expulsive action of the 
intestinal muscular fibers, and it mechanically forces 
accumulated faecal matter toward the natural gate 
of exit. 

(c) Colic. Every experienced mother knows how 
often "wind," the cause of colicky pain, is expelled 
from the stomach or intestines by gently rubbing 
the abdomen with the hand. Any approach to 
scientific manipulation is much more efficient, and 
two or three minutes' eflleurage may be resorted to, 
as the urgency of the symptoms requires, with the 
18 



274 HYGIENE OF THE NURSERY 

most satisfactory effect. In this connection it must 
be remembered, also, that rubbing of the feet to 
increase the circulation is an important aid in 
relieving colic. 

(d) General debility and impoverished blood. 
These conditions are much benefited by short, 
frequently repeated courses of massage. In the 
convalescence from many diseases — both acute and 
chronic — the above conditions are present, and 
manipulation, by improving general nutrition, leads 
to a rapid restoration of strength. 

(e) Infantile paralysis. Here massage of the 
paralyzed muscles brings more blood into them 
and maintains their nutrition until, in favorable 
cases, new nerve cells take on the function of those 
which have been destroyed. 

In infantile paralysis the affected members are 
always cold, and the muscles contract feebly, if at 
all, under the influence of electricity. By system- 
atic massage — petrissage combined with efneurage 
and both performed centripetally — an improvement 
takes place with more or less rapidity. The first 
indication of this is an increase in the temperature 
of the parts, continuing for several hours after the 
rubbing. Then the electrical contractility of the 
muscles begins to return, and they respond to a 
battery- current that at the commencement is entirely 
inoperative. 



MASSAGE 275 

In recent cases the sittings should be of short 
duration and frequently repeated, five to ten min- 
utes, three or four times daily. As improvement 
advances, the frequency may be reduced, and in 
chronic cases twice a day will be sufficient at any 
time. 

Electricity is of great aid in the treatment, but it 
does not take the place of massage, for while it 
causes contraction and congestion of the muscles 
and an accumulation of blood in the skin, it does 
not have the same power of arresting rapid wasting. 
This method of treatment should never be under- 
taken without the counsel of a physician. 

(J) St. Vitus' s dance (chorea). So far as this 
branch of the management of chorea is concerned 
it requires to be aided by proper diet and rest in 
bed. On the onset of an acute attack the patient 
is put to bed, given a full supply of good food, and 
allowed to rest for two days without massage. 
Should the jerking movements be very violent, the 
sides of the bed are padded to prevent the child 
bruising himself, or, if too violent for this, to give 
security, he is slung in a hammock. At the end 
of this time the regular treatment is initiated. (For 
diet and regimen in chorea see page 265.) After 
two or three weeks of full feeding and rest and 
massage the patient should be able to sit up in bed, 
well supported by pillows, and may have a few toys 



276 HYGIENE OF THE NURSERY 

to play with. It is a golden rule, however, never to 
hurry a patient with chorea out of bed. The mus- 
cular strength is more quickly recovered while at 
perfect rest, and too early exertion often causes a 
relapse. While carrying out this plan appropriate 
medical treatment should be employed. 

(g) Among other nervous diseases in which 
massage is practised with success are facial paraly- 
sis; neurasthenia and spinal irritability occurring 
in girls about the approach of puberty, and that 
painful condition of rheumatic origin so often en- 
countered in young subjects and known as "grow- 
ing pains." 

(h) Accumulations of watery fluid between the 
lungs and the chest wall (pleuritic effusions), en- 
larged glands, and stiffened rheumatic joints are all 
benefited by rubbing. In these special instances 
the manipulations are generally combined with the 
use of ointments or lotions, though the curative 
effects cannot be attributed to the latter alone. 

In concluding the subject of massage in child- 
hood, it is a point of importance to mention that 
those cases in which the manipulation is imme- 
diately followed by a sensation of comfort or by 
refreshing sleep are most benefited by it. On the 
contrary, those cases that are stimulated, derive little 
benefit, and perhaps positive injury from rubbing. 
This I have especially noted in cases of general 



277 



debility and impoverished blood, and my own 
experience has been confirmed by a number of 
practical observers in whose judgment I have the 
greatest confidence. 



CHAPTER XI. 

EMERGENCIES. 

In Chapter I, attention was directed to certain 
deviations from the features of health that should 
lead the mother or nurse to suspect the onset of 
disease. In addition to these, it is of great service 
to take into account the four seasons of the year, 
and to be informed of what diseases generally pre- 
vail during each. 

In the late fall and early winter catarrhal affec- 
tions are most apt to occur. In catarrh there is 
an increased secretion of mucus from the lining 
membrane of either the nose, the throat, the air- 
tubes or the digestive canal, attended by fever, loss 
of appetite, thirst and lassitude, with sneezing, 
hoarseness, cough, vomiting or diarrhoea, accord- 
ing to the situation of the disease. 

As winter advances, the bronchial tubes, the 
lungs themselves and their investing membrane, 
the pleurae, are liable to attack, and the signs of 
bronchitis, pneumonia, or pleurisy may be developed. 

In the changeable weather of spring, together 
with the catarrhal inflammatory disorders already 



EMERGENCIES 279 

mentioned, epidemics of measles, scarlet fever, 
and chicken-pox are most prevalent; while during 
the summer months disorders of the bowels, such 
as diarrhoea, "summer complaint" and cholera 
infantum, swell the mortality lists of the larger 
cities. 

Again, the influence of any hereditary tendency 
to disease should always be present in the mother's 
mind, as this not only makes her alive to the possi- 
bility of the onset of illness and leads her to seek 
medical advice in time, but also induces her to 
shield anxiously her child from known exciting 
causes, and to adopt hygienic measures calculated 
to overcome the constitutional predisposition. 

In considering the question of emergencies, un- 
der which term will be included both accidents and 
certain conditions of disease, no reference will be 
made to the management of serious disorders. 
These, even in their earliest stages, must receive 
the attention of a physician. 

ACCIDENTS AND DISORDERS OCCURRING AT 
BIRTH OR SOON AFTER. 

INJURIES RECEIVED DURING BIRTH. 

The shape of the head is sometimes altered by 
the compression it is subjected to during a pro- 
longed and difficult labor. The deformity is usu- 
ally in the direction of elongation, the distance 



280 HYGIENE OF THE NURSERY 

from the chin to the back of the head at times 
measuring six inches or even more. There is no 
ground for apprehension in these cases, and the 
head will regain its natural shape without mechani- 
cal interference. 

Swellings upon the scalp are quite common. 
They are due to pressure sustained by the parts in 
labor. Such tumors gradually subside, if kept free 
from compression and frequently bathed with cool- 
ing lotions; of the latter, alcohol and water, the 
extract of witch-hazel and water, or diluted lead- 
water are serviceable. 

The face may be congested and blackened, and 
the features disfigured and distorted from the same 
cause. A natural appearance, however, will be 
recovered in a few days without any treatment. 

BLEEDING FROM THE NAVEL STRING. 

This serious accident occasionally occurs some 
hours after birth. It arises from the cord being 
carelessly tied or from its being unusually large at 
birth and subsequently shrinking, so that the liga- 
ture ceases to close the blood-vessels. 

To arrest the hemorrhage, the infant's clothes 
and flannel binder must be removed and the cord 
exposed; then a new ligature, composed of six 
strands of strong linen thread, must be applied half 
an inch nearer the body than the original one, and 



EMERGENCIES 281 

tied tightly enough to compress thoroughly the 
vessels, but not so tight as to cut through the cord. 

ULCERATION OF THE NAVEL. 

The cord generally separates from the navel 
between the fifth and fifteenth day after delivery, 
and the parts should then heal without trouble. 
Occasionally, after the falling of the cord, a small 
growth, about as large as a pea, appears on the 
navel, giving rise to a discharge of thin liquid. This 
may be relieved by applying a little powdered alum 
and afterward dressing with vaseline or oxide of 
zinc ointment. 

Again, though rarely, excoriation of the navel 
and surrounding skin takes place, and rapidly 
spreads, assuming an inflammatory character. 
The attention of the physician must be called to 
this Apply a warm-water dressing should his 
visit be delayed. 

SECONDARY BLEEDING FROM THE NAVEL. 

At the time of, or several days after, the sepa- 
ration of the cord, bleeding may take place from 
the navel. In this event, which is fortunately un- 
common, place the point of the finger over the part 
and steadily, but gently, press it until medical aid 
can be obtained. 

When a bleeding growth appears at the navel, 



282 HYGIENE OF THE NURSERY 

wind a piece of very narrow tape closely around it 
and leave the whole undisturbed. Under these cir- 
cumstances the hemorrhage quickly stops and the 
growth soon sprouts over the upper edge of the tape 
and, strangulating itself, drops off. 

YELLOW STAINING OF THE SKIN. 

During the first few days of life, especially after 
a difficult and tedious birth, there is apt to be intense 
congestion of the skin, followed, as the redness fades, 
by a brownish yellow discoloration. This usually 
disappears by the tenth day. The coloration resem- 
bles that of true jaundice, but there is no yellow 
staining of the whites of the eyes, nor change in 
the color of the urine or faeces. Real jaundice 
occasionally occurs and is a serious condition, 
requiring careful management. 

RETENTION OF URINE AND F^CES. 

Infants frequently do not pass urine for many 
hours after birth, sometimes not for days. This 
may be due to complete want of secretion or to 
some temporary engorgement of the kidneys, which 
can be relieved by drawing the blood to the surface 
by immersion in a warm bath — a procedure to be 
adopted in all cases in which no urine is voided 
during the first twenty-four hours of life. Often, 
in lieu of the bath, it will suffice to lay a piece of 



EMERGENCIES 283 

flannel, wrung out of hot water, upon the lower 
third of the abdomen, the region over the bladder. 
Occasionally some physical malformation leads 
to retention of urine, and it is the duty of the nurse 
to be on the lookout, so that she may early call the 
physician's attention to the matter. The same con- 
dition may also prevail in the bowel, and when 
twelve hours elapse without any evacuation the 
parts ought to be carefully examined. 

SWELLING OF THE BREASTS. 

At birth, or within the following day or two, the 
mammary glands of an infant may swell, become 
hard and painful, and secrete a thin fluid much 
resembling milk. Never make any pressure to re- 
move the secretion, as it may lead to inflammation. 
When the swelling is moderate, judicious inaction 
is best, but in severer cases, when the surface is red, 
and the parts much swollen, and hard and tender to 
the touch, a hot-water dressing must be constantly 
applied. 

INFLAMMATION OF THE EYES. 

This is a most important condition, and, from the 
outset, requires the attention of the physician and 
the greatest care on the part of the nurse. 

The inflammation usually comes on about three 
days after birth, in the following manner: on wak- 



284 HYGIENE OF THE NURSERY 

ing from sleep, the child's eyelids are slightly glued 
together; their edges, particularly at the corners, 
are redder than natural, and on turning down the 
lower lid a little white matter will be observed 
on the inside. Light causes pain and there is a 
tendency to keep the eyelids closed. After a short 
time the lids swell, become red on their external 
surfaces, and a large quantity of matter is secreted 
and constantly pours from the eye. Apart from 
pure medicinal treatment the nurse must keep the 
eye free from discharge by constantly washing away 
the matter secreted with boric acid solution. Burn 
the cotton used in this process at once, and it is 
most important for the attendant not to carry any 
of the discharge to her own eyes. 

HARELIP AND CLEFT PALATE. 

These are deformities requiring the attention of 
the surgeon, and under ordinary circumstances his 
aid should, in case of simple harelip, be sought 
within the first six months of the child's life, so that 
the operation may be well over before dentition 
begins. The fourth month is the period of election, 
but should there be difficulty in sucking and any 
evidences of inanition, the operation may be per- 
formed at an earlier age. The operation for cleft 
palate should not be undertaken before the end of 
the second year. 



EMERGENCIES 285 

So far as the mother is concerned, the question 
of importance is whether or not there is any inter- 
ference with the act of sucking. If harelip be 
trifling, the infant will be able to suck, provided the 
mother's nipple be large and the milk flow freely; 
when the reverse is the case, resort to a nipple 
shield. In grave cases, especially when harelip is 
associated with cleft palate, the child is unable to 
suck either from the breast or from the bottle, and 




Fig. 24. — Tip with False Palate. 

must be fed from a spoon. Occasionally one can 
succeed in feeding a child so affected from a bottle, 
by resorting to a false palate. This consists of a 
bit of thin india rubber, cut the size and shape of 
the roof of the mouth and fastened by several firm 
stitches to an ordinary bottle tip (Fig. 24). In 
using this instrument, the nurse must insert it into 
the mouth in such a way that the rubber diaphragm 
will come uppermost and bridge over the imperfect 
portion of the palate. 



286 HYGIENE OF THE NURSERY 

TONGUE-TIE. 

In this condition the bridle beneath the tongue 
is either too short, or is attached so near the tip of 
the tongue as to interfere, at first, with the move- 
ments of the organ in sucking, and, afterward, in 
speaking. Although frequently suspected, it in 
reality occurs very rarely. The best way to deter- 
mine if tongue-tie exist or not, is to watch whether 
the infant can protrude the tip of the tongue beyond 
the lips. If so, it will be able to suck a good nipple 
readily, and nothing need, nor ought, to be done. 
Should the reverse condition prevail, it will be 
necessary to nick the bridle, and, as there is con- 
siderable danger of hemorrhage in this operation, a 
surgeon must always be consulted. 

ACCIDENTS AND DISORDERS OCCURRING IN 
INFANCY AND CHILDHOOD. 

BRUISES. 
A contusion or bruise must be treated as soon 
as received, if one would relieve pain, lessen swell- 
ing and prevent the formation of a black and blue 
spot. Compresses wet with hot water, a light ice 
bag,* or a lotion of fluid extract of witch-hazel, are 
the best remedies. A bruise upon the head in the 

* Heat and cold act in the same way upon the blood-vessels, 
contracting them and preventing the transudation of blood. It 
is the changes occurring in the blood after leaving the vessels 
that produce the discoloration. 



EMERGENCIES 287 

case of a young infant, and especially when followed 
by paleness and vomiting, is not to be carelessly 
overlooked, since it is sometimes the cause of 
convulsions. 

SPRAINS. 

Do not make light of a severe sprain, for the 
consequences are often more lasting than those of a 
broken bone. 

Much care and patience will be required in the 
management of sprains, the great point being to 
secure rest for the injured part. Should the knee 
or ankle-joint be involved, put the patient to bed 
and swathe the part in a hot-water dressing, or in 
compresses soaked with fluid extract of witch- 
hazel. When a joint of the upper extremity is 
involved, it is, of course, unnecessary to confine 
the child to bed; but at the same time the limb 
must be placed in such a position as to be as quiet 
as possible, while the local applications already 
mentioned should be employed. Later, passive 
motion must be practised in order to prevent per- 
manent stiffness. A sprain, however, needs the 
surgeon's attention as much as a broken bone. 

FRACTURES. 

The breaking of a bone is indicated by deformity 
of the limb, such as bending, shortening, or twist- 



288 HYGIENE OF THE NURSERY 

ing, and when this occurs, much suffering to the 
patient and injury to the part may be saved by a 
little careful management. In lifting the child 
from the spot where the accident happens and carry- 
ing him to a bed, it should be one person's duty to 
support tenderly the injured limb, instead of allow- 
ing it to dangle loosely. Once in bed, lay it upon a 
soft, rather broad pillow; double this around the 
limb, and tie up tightly so as to afford protection 
from jars or shaking. 

Beyond this, nothing should be undertaken until 
the physician arrives, except — in case of fracture of 
the lower extremity — the preparation of the bed. 
This consists in arranging a firm, though not too 
hard, mattress, with two or three under blankets 
for the sake of warmth. 

CUTS. 
These may be clean, as when made by a knife; 
torn, by a broken plate; or abraded, by a fall on 
hard, rough ground. If large and deep, the sur- 
geon should be called at once. In trifling cases, 
the nurse must first thoroughly cleanse the wound 
by sponging it with hot water and then with an 
antiseptic solution of bichloride of mercury, I 
part to 3000, using a ball of absorbent cotton for 
a sponge. Any flow of blood should be checked 
by pressure, by the application of hot water, or — 



EMERGENCIES 289 

should the hemorrhage be obstinate — by the use of 
a solution of alum. In the case of a knife cut, the 
next step is to press the edges together, fix them in 
this position by applying narrow strips of surgeon's 
adhesive plaster at short intervals across the wound, 
and cover the whole with antiseptic gauze. A 
torn wound may be dressed in the same way, but 
greater care is required to coadapt the edges. For 
abrasions, the best application is a piece of lint 
or absorbent cotton saturated with the bichloride 
solution already mentioned, fixed by a bandage. 
Neither dressing need be removed unless disar- 
ranged or in the event of suppuration taking place; 
in the latter case the wound must be washed with 
the antiseptic solution and redressed each day. 
When an artery is cut, the flow of blood must be 
checked by pressure on the vessel above the seat of 
injury; in the case of a vein, below it. Arterial 
blood flows in jets and is scarlet; venous blood runs 
in a continuous stream and is purple in color. 

It is most important to remember that the bichlo- 
ride solution is an active poison and that, conse- 
quently, it must be most carefully handled and 
guarded. It should be kept in a blue bottle labeled 
"Poison," and never left where there is the slight- 
est risk of its being tasted and swallowed by the 
child or attendants, and never placed with the ordi- 
nary nursery medicines. 
19 



290 HYGIENE OF THE NURSERY 

BURNS AND SCALDS. 

The danger from burns or scalds is in direct pro- 
portion to the extent of surface involved and the 
depth of tissue destroyed. Fortunately, the ma- 
jority of cases are trifling, and usually the hands or 
face are the parts that suffer. In these instances 
there are two things to be done: first, to relieve 
pain, and second, to encourage healing. To accom- 
plish the former, apply a saturated solution of 
baking soda; for the latter use some mild ointment 
— fresh lard, for example — and keep the injured 
part protected from the air by a dressing of cotton 
batting. 

Should the child's clothing take fire, remember 
that an upright position not only favors the spread 
of the flames, but encourages their approach to the 
neck and head. Any movement of the body, too, 
aids the flames by bringing fresh currents of air in 
contact with the burning materials. Therefore, do 
not let the child run about, but seize him, throw 
him down upon the floor and envelop his body 
closely in the hearth rug or a woolen tablecloth. 

Should the child have fallen into a tub of scald- 
ing water, remove him immediately, of course, and 
undress him. In taking off the clothing, be careful to 
do it so gently as not to break the blisters produced 
by the moist heat; and should the underclothing 
stick anywhere to the surface, the garments must 



EMERGENCIES 201 

be cut away piecemeal, leaving the adherent por- 
tions untouched. 

After the above preliminaries put him, in either 
case, at once to bed. Next, prepare a number of 
pieces of old muslin corresponding in size with the 
injured areas, spread these with fresh lard or cosmo- 
line, apply them and cover all with a thick layer of 
cotton batting and fix with bandages. Should the 
patient complain of cold hands or feet, or of faint- 
ness, a little whiskey or brandy may be adminis- 
tered and artificial heat applied to the extremi- 
ties if these be uninjured. Nothing else should 
be done without the physician. 

STIXGS OF INSECTS. 
Children, being more ignorant, are more fre- 
quently stung by bees, wasps, and other insects, 
than adults. Examine the wound the first thing 
with a magnifying glass, and if the sting be still in 
the tissues, extract it with a pair of tweezers, or 
squeeze it out by firm pressure in the neighborhood 
of the puncture. After this, apply aromatic spirits 
of ammonia or eau de Cologne. These will relieve 
the pain and itching. When the sting produces 
great pain and inflammation, apply a flaxseed poul- 
tice for twenty-four hours. The frequent use, 
afterward, of camphorated soap liniment will be 
productive of good results. 



292 HYGIENE OF THE NURSERY 

FOREIGN BODIES IN THE EAR. 

When a foreign substance has entered the ear, 
the plan for its extraction depends somewhat upon 
the nature of the material. In any case, however, 
bend the child's head toward the affected side, 
cause him to open his mouth as wide as possible, 
and at the same time gently pull the external ear 
upward and backward. In this way the external 
canal of the ear is straightened and stretched to its 
widest extent, and a small body like a bead may 
drop out. Another method is to wash the foreign 
body away with warm water and a syringe. Should 
the substance be of a nature to increase in size by 
absorbing moisture, such as a pea or bean, its 
extraction must be left for the physician, though 
it is to be delayed no longer than absolutely neces- 
sary. When an insect enters the ear, the external 
canal must at once be filled with fresh olive oil. 

FOREIGN BODIES IN THE EYE. 

A simple plan for removing cinders and the like 
from the eye is to pull the upper eyelid forward and 
downward, by grasping the eyelashes, and direct 
the child to look upward. In this way the lashes of 
the lower lid are made to sweep over the inside of 
the upper one, and thus may brush away the foreign 
body. If this be unsuccessful, and if the offending 



EMERGENCIES 



'-93 



substance be in sight, remove it with the corner of 
a fine handkerchief. If not seen on the eyeball, it 
must be looked for beneath the lids. It is easy 
enough to pull down the lower lid and examine its 
internal surface; in the case of the upper lid, how- 
ever, it is necessary to perform eversion; this is 
done by drawing the lid downward and forward, and 
turning it over a thin lead pencil (Fig. 25). Direct 




Fig. 25. — Method of Everting Upper Eyelid. 



the child, in the meanwhile, to look down. When 
the intruding body is disclosed by this process, it 
may be brushed away by a little cotton twisted 
upon the end of a match stick, or by a small camel's- 
hair brush; the touch must be very gentle, and no 
prolonged effort made if the mote be imbedded. 
Treat any slight irritation following this accident 
and the process of removal by frequent appli- 
cations of hot water. 



294 HYGIENE OF THE NURSERY 

FOREIGN BODIES IN THE NOSE. 

Children frequently insert shoe-buttons, peas, 
beans, and other small objects into the nose. When 
these are not too firmly fixed, or have not been 
pushed too far up, they may be removed by closing 
the opposite nostril and causing the child to blow 
his nose forcibly. Should any difficulty be expe- 
rienced, it is better to consult a physician than use 
persistent force. 

FOREIGN BODIES IN THE THROAT. 

A large, unchewed mass of food, a fish-bone, or 
some metallic substance, such as a piece of money, 
may become lodged at some point in the throat. 

When this occurs, immediately insert the finger 
and thumb into the mouth, pass them as far down 
the gullet as possible, and if any object be felt, make 
an attempt to pull it forth. 

Instead of lodging in the upper part of the gul- 
let, the foreign body may be arrested midway in its 
course to the stomach. Let the child then partially 
masticate and swallow a piece of bread and several 
mouthfuls of water, which will probably assist the 
object's passage into the stomach; if not, medical 
skill will be required. 

Foreign bodies, such as buttons and coins, and 
even needles and pins, that pass directly into the 



EMERGENCIES 295 

stomach, give rise to little trouble, and soon find 
their way through the alimentary canal, and are 
voided from the rectum with the ordinary faecal 
evacuations. Laxative medicines are never to be 
used unless the bowels be absolutely confined, and 
then moderate doses of castor oil are the most 
suitable. 

BLEEDING FROM THE NOSE. 

Hemorrhage from the nose is sometimes so ex- 
cessive as to lead to debility, or even threaten serious 
results. An injury or abrasion of the lining mucous 
membrane is the usual cause of hemorrhage, though 
it may result from certain constitutional conditions. 
To arrest the bleeding, put the child upon a bed, 
with the head and shoulders well elevated. First 
make pressure, with the thumb and index finger, on 
the root of the nose, i. e., that portion between the 
eyes, or on either side of the nostrils where the 
blood-vessels ascending from the lip are felt to 
pulsate. Should this fail, plug the nostril from 
which the blood flows with a cone-shaped pledget 
of absorbent cotton or lint; this may either be dry 
or saturated with a solution of alum and water as 
hot as can be borne. The inhalation of the vapor 
of spirits of turpentine, or the immersion of the 
feet and legs in a hot mustard foot bath, are each 
successful in some cases. If the bleeding be obsti- 



296 HYGIENE OF THE NURSERY 

nate, apply a piece of ice wrapped in flannel to the 
forehead or the back of the neck. 

EARACHE. 

Earache is a very common cause of crying in 
infancy and childhood. Screaming from earache 
may be distinguished from that due to pain in the 
bowels, another fruitful source of crying, by the 
former being more continuous, and by the child 
frequently carrying his hand to his head; again, in 
earache the passages from the bowels are natural, 
while in bowelache they are usually altered in 
character and offensive. 

Douche the ear gently with hot boiled water or 
normal saline solution and put into the ear, for a 
short distance, a small piece of absorbent cotton 
saturated with a four per cent, solution of cocaine. 
At the same time dry or moist heat may be applied 
to the external ear. 

COLDS AND COUGHS. 
A cold in the head is indicated by water eyes, 
sneezing — with a discharge of mucus from the nose 
— and a nasal voice. Simple remedies are often 
efficacious. Frequently grease the forehead and 
bridge of the nose with mutton suet; insert a little 
vaselin in the nasal orifices, and, should the skin 
be hot, administer a mustard foot bath. 



EMERGENCIES 297 

An ordinary cold — or, in medical language, a 
bronchial catarrh — is usually preceded by a cold 
in the head, and is indicated by a hoarse cough, in- 
creased rapidity of breathing, and fever. 

The methods recommended for cold in the head 
are also useful here. In addition, rub the chest 
thoroughly, three times a day, with a liniment of 
turpentine and sweet oil, one part to three; keep 
the child in one room at a temperature of 72 F.; 
allow a light diet, and summon medical aid. 

SPASMODIC CROUP. 

In this condition there is a mild grade of catarrh 
of the lining mucous membrane of the larynx, accom- 
panied by marked spasm of the laryngeal muscles. 
This spasm is an outcome of the excessive reflex 
nervous irritability common to young children and 
gives rise to the characteristic features of the 
disease. 

Spasmodic croup may occur during the first six 
months of life, but is most frequent from this age 
up to the third year, when the tendency gradually 
diminishes until after the fifth year attacks are 
unusual. While it occurs in both healthy and 
delicate subjects, some children possess a peculiar 
susceptibility, in which heredity seems to play a 
part. One attack predisposes to others. The 



298 HYGIENE OF THE NURSERY 

exciting causes are exposure to cold, dampness, 
and high winds, overeating, and indigestion and 
constipation. 

An attack may come on suddenly or be preceded 
by hoarseness or by the symptoms of nasal catarrh. 
The precedent symptoms usually appear about 
midday and gradually increase. As evening ap- 
proaches an occasional hollow, barking, evidently 
painful cough is noticed and the voice is very hoarse; 
toward midnight the cough becomes more brazen 
and more frequent and the breathing difficult. In 
very mild cases these disturbances are not severe 
enough to wake the child, but when the laryngeal 
spasm is marked, respiration becomes very labored, 
especially the inspiratory movement, which is at- 
tended by a hissing sound and by visible retraction 
of the soft parts above and below the breast-bone. 
Terrified by the want of air the child sits up in bed 
and struggles for breath. The face has an anxious 
expression; the cheeks are flushed, although the 
lips may be bluish, and the forehead is covered with 
drops of perspiration. The breathing is slow and 
labored and any excitement or effort increases the 
difficulty. The voice is hoarse but not lost. The 
cough has a characteristic brazen tone. The pulse 
is increased in frequency, and while the tempera- 
ture may remain normal it is usually moderately 
elevated. 



EMERGENCIES 299 

If untreated such an attack slowly disappears, 
and in the course of three or more hours the child, 
exhausted, drops to sleep. Next day, with the ex- 
ception of hoarseness and an occasional barking 
cough, nothing seems amiss; but in the late after- 
noon or near midnight the spasm returns and is 
even more severe than before, and after a second 
free day is apt to be repeated on the succeeding 
night, although this third attack is, as a rule, much 
less severe than the others. 

The treatment of an attack of croup must be 
left to the physician, but a mother can do much in the 
way of prevention. When the susceptibility exists, 
the child must be carefully guarded against exposure 
to cold, high wind and dampness; must be properly 
fed, never allowed to become constipated, and 
everything known to induce an attack must be 
rigidly avoided. Plenty of outdoor life and fresh 
air, under proper restrictions, are to be recom- 
mended. All local excitant conditions — as adenoid 
growths or hypertrophied tonsils — should receive 
attention, and if there be general ill health and want 
of tone, the system should be built up by food and 
tonics. 

Upon the onset of hoarseness and a croupy cough, 
syrup of ipecacuanha should be given in doses of 
3 to 5 drops in a little sweetened water every two 
hours, and the throat and anterior part of the chest 



300 HYGIENE OF THE NURSERY 

thoroughly rubbed with camphorated oil every 
four hours. 

When an attack occurs — before the arrival of the 
physician — hot compresses should be applied to 
the region of the larynx, and sufficient syrup of 
ipecacuanha administered to secure free emetic 
action, and in this way relax the laryngeal spasm — 
15 to 20 drops every fifteen minutes, for three or 
four doses, with intermediate draughts of warm 
water, will usually accomplish the result quickly. 
At the same time moistening the air of the chamber 
with vapor from a croup-kettle will add greatly to 
the comfort of the patient; or better, a canopy or 
tent may be placed over the bed and the steam 
introduced beneath this. 

VOMITING. 

The most healthy infant, even though it be fed 
at a normal breast, often expels a portion of each 
feeding. This is an act of regurgitation rather than 
vomiting, and is, in reality, a natural method of 
relieving an overburdened stomach. 

Vomiting proper is preceded by the sensation of 
nausea; is followed by lassitude, and is often at- 
tended by fever. It indicates some disorder of the 
stomach. For its relief, perfect rest for the whole 
body; several hours' starvation, or rest for the 



EMERGENCIES 3OI 

stomach, and a reduction in the quantity and 
strength of the food, are necessary. Bits of ice, 
soda-mint, lime-water, and a mixture of equal quan- 
tities of cinnamon-water and lime-water, in tea- 
spoonful doses, are simple and efficient remedies; a 
weak mustard plaster placed over the pit of the 
stomach is always useful. Should the symptom be 
obstinate, however, the case becomes too serious for 
the mother to manage on her own responsibility. 

COLIC. 

Colic is a very common affection of infancy. It 
usually occurs in the period between birth and the 
end of the third month, and gives rise to much dis- 
comfort, both to the infant and its attendants, by 
causing fretfulness, crying and wakefulness. The 
treatment is very much one of careful regula- 
tions of the diet. Still, there are some domestic 
remedies which may be used safely and with suc- 
cess. Thus, the abdomen should be anointed twice 
a day with warm olive oil and enveloped in a broad 
flannel binder. It is even more important to keep 
the feet warm, and for this purpose thick socks or 
long woolen stockings should be worn, and, in bad 
cases, artificial heat must be applied by hot-water 
bottles. Medicines are indicated chiefly during 
attacks of pain. A serviceable prescription is ten 



302 HYGIENE OF THE NURSERY 

drops of gin in a teaspoonful of sweetened warm 
water, or a small teaspoonful of hot soda-mint. It 
is also well to administer five to ten drops of. essence 
of pepsin or of diazyme essence after each nursing. 
When a paroxysm of pain is violent enough to 
lead to depression of the fontanelle and threaten 
collapse, place the infant in a warm bath for five 
minutes. After removing and carefully drying 
him, wrap him in a blanket; put a flax-seed poultice 
with a little mustard flour over the abdomen; apply 
a hot- water bottle to the feet; relieve the bowels by 
an enema of warm saline solution, and by the mouth 
give him ten drops of gin or brandy in warm water. 
If the fontanelle still remains depressed, continue 
the stimulant in doses and at intervals proportioned 
to the urgency of the symptoms. 

CONSTIPATION. 

Habitual constipation is such a common occur- 
rence in infancy and childhood that it warrants a 
somewhat detailed consideration. The methods 
that may safely be employed to clear the lower 
bowel of accumulated faeces, or, in other words, to 
relieve the actual state of constipation, will be first 
noticed, for this is always a necessary step when 
there is painful straining, and in case there has been 
no movement for a day or more. For this purpose 



EMERGENCIES 303 

injections are most efficient, and when given with 
care are entirely free from danger. 

A serviceable plan is to inject into the rectum, 
according to the age of the patient, from one to four 
teaspoonfuls of warm olive oil; allow it to remain 
for six hours, and then use one or more injections 
of normal saline solution. The preliminary in- 
jection of oil softens the faeces, while the subsequent 
ones have the additional effect of distending the 
walls of the rectum, thus bringing about muscular 
contraction and expulsion of its contents. Should 
a compact faecal mass be present at the anus and 
be too bulky to escape— a condition often visible 
during straining — more liquid must be injected, 
and if this fails the mass must be broken up by the 
finger and its passage assisted by gentle pressure 
upon the parts behind the anus while expulsive 
efforts are being made. The process of breaking 
up is easy, as the anus is widely distended at such 
times. In obstinate cases little result may follow 
a single employment of the injections, though a 
course of one or two oil injections and purgative 
enemata for several successive days rarely fails to 
empty the bowel. 

The best syringe for children is one of hard rubber 
with a long, smooth nozzle, having a capacity 
of six or eight fluidounces. When oil is injected, 
the intention being to have it remain in the rectum 



304 HYGIENE OE THE NURSERY 

and act mechanically on the faeces, its retention is 
best secured by firmly pressing a warmed pad of 
flannel against the anus for five minutes after the 
insertion, the patient, in the meanwhile, lying upon 
his back. The laxative enemata must vary in bulk 
with the age of the child, or, in other words, with 
the capacity of the rectum; two fluidounces (four 
tablespoonfuls) will be sufficient for an infant of six 
weeks, while from four to eight fluidounces are 
required at the age of two years. The quantity of 
salt to be used must depend upon the quantity of 
water — half a teaspoonful of salt to eight ounces of 
water being the proper proportion. After drawing 
the fluid — which must be tepid — into the syringe, 
grease the nozzle well and gently insert it into the 
anus, directing the point a little toward the patient's 
left; next slowly force down the piston until all the 
liquid is expelled or complaints of pain indicate that 
the bowel is sufficiently distended. If it be possible 
to secure retention for a moment or two by pressure 
on the anus, the movement will be freer and easier 
than if the fluid be allowed to flow away at once. 
The best positions for the child are either on his 
back with his legs well drawn up, or resting on his 
abdomen across the nurse's lap. 

Injections of glycerin and glycerin suppositories 
are also very useful for the purpose of unloading 
the lower bowel. When glycerin is employed, 



EMERGENCIES 305 

the quantity to be injected varies from one to two 
teaspoonfuls, according to the age of the child, 
and should be diluted with an equal quantity of 
pure water. The best instrument to use is the bulb 
syringe, previously recommended (page 256). 

For the prevention of further constipation the 
diet must be regulated according to the rules given 
in Chapter IX, and besides regulating the food and 
hours for meals, bathing, sleep, exercise and cloth- 
ing, care must be taken to establish fixed habits of 
defecation. In my experience very young infants 
can be taught to use a chamber, and if this vessel be 
presented each day at the same hour he soon falls 
into regular ways. 

The training should be begun after the fourth or 
fifth week in the following way: every morning and 
evening, at a fixed hour after feeding, the nurse 
places a small chamber between her knees, and upon 
this holds the infant with its back against her chest 
and its body firmly supported. Then to excite 
expulsive efforts and suggest the object of the 
position, a soap-stick is inserted a short distance 
within the rectum. Soon, however, the local 
irritation becomes unnecessary, the position alone 
being sufficient to quickly ensure an evacuation. 
Should faulty habits be established or constipation 
exist, resort to injections and abdominal massage at 
the same hour each day. 



306 HYGIENE OF THE NURSERY 

After the third year the best period of the day 
for the bowel to be moved is immediately after 
breakfast, and no call of duty or pleasure should 
be allowed to interfere. When constipation is to 
be overcome natural efforts must be made then. 
These efforts may at first be ineffectual, but 
much can be accomplished by perseverance in a 
daily, sustained effort, for about ten minutes. 
When this plan fails, use injections or other 
methods of relief, taking care to keep to a cer- 
tain hour, that the formation of a habit may be 
encouraged. 

Thorough rubbing of the abdomen is often suc- 
cessful in inducing a movement of the bowels. 
Gentle pressure should be made with the palm of 
a well-warmed hand, and the movement directed, 
first, from the brim of the pelvis on the right side, 
upward to the rib margin, then across from the 
right to the left, and finally downward on the left 
side from the margin of the ribs to the brim of 
the pelvis again. Such manipulation excites peris- 
taltic action, and encourages the passage of the in- 
testinal contents along the large bowel toward the 
anus. Ten minutes is quite long enough to continue 
the rubbing. The manipulation may be rendered 
more effective by using warm sweet oil as an in- 
unction. 

With children of six years and upward, daily 



EMERGENCIES 307 

cold spongings of the body are very beneficial, 
followed by frictions with a coarse towel until the 
surface is red. 

Manna, phosphate of sodium, and gluten or soap 
suppositories are among the medicines that may be 
safely used in the nursery. 

Manna, which imparts a sweet taste, may be 
dissolved in the food, and given from the bottle as 
often as required; a piece as big as a pea, once, 
twice, or three times a day, will be sufficient for an 
infant of six months. 

Phosphate of sodium — an admirable laxative — 
can also be administered with the food; five or ten 
grains, three times daily, is the proper dose at the 
same age. 

Soap suppositories must vary in strength with the 
age. At two months one grain of castile soap to ten 



Fio. 26. — Soap Stick. 

grains of cocoa butter is the proper proportion; at 
one year the quantity of soap may be increased to 
five grains in each suppository, and so on. A 
substitute for soap suppositories may be prepared 
in the nurseryj as follows: Cut from a bar of good 



308 HYGIENE OF THE NURSERY 

castile soap a piece two inches long and half an 
inch thick. Scrape this into a cone, pointing one 
end like a sharpened pencil, but with a blunter 
point and more gradual slope; make it quite 
smooth by rubbing the surface with a wet rag (Fig. 
26). When the soap stick is used anoint the pointed 
end with vaseline and gently insert it into the rectum 
and hold it there until the action begins. It is not 
desirable to leave any fragments of soap in the 
rectum. Glycerin suppositories are very efficient, 
but are too irritating for continuous use. 



CONVULSIONS. 

Convulsions arise from so many diverse causes 
that it is impossible to indicate more than what is 
to be done during the fit and prior to the arrival 
of the physician. 

When the attack comes on, the child must be 
undressed at once and plunged into a hot bath 
for five minutes; this bath must contain enough 
mustard flour to stimulate the skin thoroughly. 
This usually restores consciousness and checks the 
muscular twitching. Should there be a distinct 
history of overloading of the stomach, give an 
emetic of ipecacuanha, and after this has operated, 
a purgative dose of castor oil. One or more doses 
of bromide of potassium, five to ten grains, accord- 



EMERGENCIES 309 

ing to the age, may also be safely given; this salt 
must always be administered in solution. 

A CHILL. 

This is always a serious occurrence and warrants 
sending for the doctor. Before his arrival, put the 
child to bed, surround him with bottles containing 
hot water, place a moderately strong mustard plas- 
ter over the abdomen or over the region of the 
heart, and administer whiskey and hot water in 
small doses and at short intervals. 

The ailments of children do not so frequently 
begin with a chill as do those of adults, but when 
they do, it is a more decided indication of the 
future gravity of the attack. 

FEVER. 

It is not my intention here to refer to the man- 
agement of the essential fevers, for I hold that 
neither mother nor nurse is capable of managing 
them without professional assistance. However, 
the following tables, exhibiting the features of 
the eruptive fevers and other contagious diseases, 
will answer some of the questions which so fre- 
quently suggest themselves to the minds of anxious 
parents. 



3io 



HYGIENE OF THE NURSERY 

ERUPTIVE FEVERS. 



Name. 


Period 
of in- 
cuba- 
tion. 


Day of 
rash. 


Character 
of rash. 


Rash 
fades. 


Dura- 
tion of 
illness. 


Duration of 
contagious- 
ness. 


Measles. .. 


10 to 

14 
days. 


4th day of 
fever, or 
after 7 2 
hours' ill- 
ness. 


Small, dull 
red pimples, 
appearing 
behind the 
ears and on 
face. 


On 7th 
day of 

fever. 


9 days. 


From first 
day, for 
exactly 3 
weeks. 


Scarlet 
Fever. 


2 to 7 
days. 


2d day of 
fever, r 
a f t e r 24 
hours' ill- 
ness. 


General rosy 
blush ap- 
pears fi r s t 
about neck 
and shoul- 
ders. 


On 5th 
day af- 
t e r fe- 
ver. 


8 or 9 
days. 
(This 
does 
not in- 
clude 
se- 
quels.) 


Six weeks 
at least. 


Typhoid 
Fever. 


10 to 

14 
days. 


7th to 
14th day. 


Rose-color- 
ed, slightly 
elevated 
spots, few 
in number, 
chiefly on 
abdomen. 


1 4 to 2 1 
days. 


Not conta- 
gious. In- 
fectious. 


Chicken- 
pox. 


12 to 
days. 


2d day of 
fever, or 
after 24 
hours' ill- 
ness. 


Appears in 
crops on 
back and 
abdomen, 
small, red 
papules rap- 
idly passing 
into globu- 
lar vesicles. 


Thin 

scabs 

form 7 to 1 2 

about days. 

4th day 

of fever. 


First day, 
for three 
weeks, r 
a full week 
after all 
dry crusts 
have d i s- 
appeared. 


Small- 
pox. 


1 2 
days. 


3d day of 
fever, or 
after 48 
hours' ill- 
ness. 


Small, hard, 
red pimples, 
becoming 
vesicles, 
then pus- 
t u 1 e s, ap- 
pearing first 
on face and 
neck. 


Scabs 

form on 

9th or 

10th day . 14 to 21 

of fever, days. 

and fall 

off about 1 

the 14th. 1 


First day, 
for about 
6 weeks. • 



EMERGENCIES 

OTHER CONTAGIOUS DISEASES. 



311 



Period 
of incu- 
bation. 



Date of 
onset of 
characteris- 
tic symp- 
toms from 
invasion. 



Characteristic 
symptoms. 



Duration of 
illness. 



Duration of 
contagious- 
ness. 



Erysipelas. . . 



3 to 

days. 



Redness, glos- 
siness, and 
pumness of 
affected skin; 
«, _ j area circum- 
d scribed, pit- 
ting and pain- 
ful to pres- 
sure, and seat 
of burning and 
smarting pain. 
Fever. 



day 



5 to 7 days; 
several 
weeks in 
cases that 
extend. 



From 1 
day for 
weeks. 













From first 










Depends 


day for 4 








False m e m- 


upon date 
of begin- 


to 6 weeks 


Diphtheria . . 


2 to s 


1 st or 2d 


brane on ton- 


but de- 


days. 


day. 


sils and other 


ning anti- 


pends up- 








parts of throat. 


toxin in- 
jections. 


on results 
f throat 
cultures. 












From onset 












f initial 








Paroxysmal 




catarrhal 








cough follow- 




symptoms 








ed by a crow- 




for 1 2 weeks 








ing inspira- 




or until 


Whooping- 
cough. 


7 to 14 


2 to 4 


tion. Parox- 


12 weeks. 


whoop 


days. 


weeks. 


ysms often 


ceases. 








end with the 




Most conta- 








expulsion f 




gious dur- 
ing whoop- 








glairy mucus 










or vomiting. 




ing stage, 
4th to 10th 
week. 








Swelling in 












front, below 












and behind 












the ear, some- 




From one 




I- to JO 

days. 




times below 


7 to 14 
days. 


day before 


Mumps 


ist day. 


the jaw; pain 
on movement 


symptoms 
appear, 








of jaw or neck, 




for .; weeks. 








and on swal- 












lowing. 







312 HYGIENE OF THE NURSERY 

It may be well to give a few directions as to the 
management of a fever before the arrival of the 
physician. Every fever — whether it be due to a 
poison circulating in the blood or to a passing irri- 
tation of little or no moment — is attended by the 
following symptoms: heat of skin, lassitude, loss of 
appetite and thirst. When these features arise, 
the mother must be on her guard and take steps 
to place her charge in the best possible condition. 
First give the child a mustard foot bath;* then put 
him to bed with only sufficient covering to keep up 
a normal body temperature. Reduce the diet to 
the simplest possible basis, dilute milk food being the 
safest. Plenty of pure cool water taken in small 
quantities at short intervals, or of some effervescing 
saline water may be allowed. Febrifuges, as 
aconite, or even sweet spirits of nitre, had best 
not be given without advice, and quinine or other 
remedies are not to be trifled with. 

Should headache be severe, place cold com- 
presses upon the forehead, or a weak mustard 
plaster (one part of mustard to six of wheat flour) on 
the nape of the neck. 

Free urination should be encouraged by hot 
compresses over the bladder, and it is well to secure 
a free action of the bowels by a mild saline laxative. 

* See page 140. 



EMERGENCIES 313 

CONTAGIOUS DISEASES AND DISINFECTION. 

There are certain points connected with the nurs- 
ing of contagious diseases and the subject of dis- 
infection that are worthy of mention. 

In every case of contagious disease, allow in the 
room only those who are necessary to nurse the 
sick. The nurse must avoid overfatigue, have 
regular meals of digestible and nourishing food, 
and fixed hours for sleep and relaxation. The 
chamber selected for the sick-room should be large, 
well ventilated, and as near the top floor of the 
house as possible. Upholstered and stuffed furni- 
ture, curtains, hangings, carpet and other articles 
capable of holding disease germs, are difficult to 
disinfect, and should be removed before the en- 
trance of the patient; in fact, to put this matter in 
a few words, the sick-room should contain only such 
furniture as will be absolutely needed by the patient 
and nurse. Scrupulous cleanliness is essential. 
Remove dirty dishes, vessels with discharges, soiled 
napkins, and the like, at once. 

Disinfectants are substances that destroy the 
infective power of infectious materials, and must 
not be confounded either with antiseptics, or arrest- 
ors of putrefaction, or with deodorizers, or neutral- 
izers of bad smells. 

In the use of disinfectants, it is important to bear 
in mind that contagious virus must be destroyed at 



314 HYGIENE OF THE NURSERY 

its source. As this, of course, is the body of the 
sick, all discharges must have their power for evil 
destroyed as soon as possible. Receive discharges 
from the mouth and nose, especially in cases of 
scarlet fever and diphtheria, in bits of rags, and 
burn them immediately after use. When the skin 
is affected, as in scarlet fever, for example, the 
flakes that fall away are highly infective. To pre- 
vent these becoming disseminated, the surface 
should be anointed several times a day with vase- 
line, lard or cocoa butter, all of which substances 
will be rendered more efficient by the addition of 
carbolic acid (1 to 40). After recovery from scarlet 
fever the child, before breaking quarantine, should 
be thoroughly scrubbed with soap and water, and 
then sponged with a solution of carbolic acid in 
water (1 to 50) or of bichloride of mercury (1 to 
5000) and finally washed in pure water. Two such 
baths, given at an interval of about twenty-four 
hours, are usually quite sufficient, and after each 
bath fresh clothing must be put on. The patient's 
hair must be cut short and the scalp cleaned and 
disinfected. 

Articles used about the patient, such as sheets, 
pillow-cases, blankets and clothes, should not be 
removed from the chamber until they have been 
soaked for at least an hour in the following disin- 
fecting fluid: 



EMERGENCIES 3 1 5 

Sulphate of zinc 8 ounces. 

Carbolic acid i ounce. 

Water 3 gallons. 

After this, place the soiled articles in boiling water 
for washing. 

Articles not requiring to be frequently changed, 
such as pillows and mattresses need disinfection. 
This may be done at the termination of the sickness, 
and is best accomplished by steam, or, if this be 
impossible, they must be burned. 

Keep a small quantity of the above fluid or of a 
solution of corrosive sublimate (i to iooo) in all 
vessels provided for receiving the discharges of the 
patient, and, after these are used, empty quickly 
and clean with boiling water. Water closets or 
privy wells into which these discharges are poured 
must also be disinfected each day with a solution 
of copperas (one pound to the gallon). In case 
of scarlet fever and diphtheria the floor of the sick- 
room should be washed once each day with a so- 
lution of bichloride of mercury (1 to 2000) and the 
walls and furniture near the patient wiped frequently 
with cloths moistened with the disinfectant. In 
diphtheria a tray of carbolic acid solution (1 to 40) 
should be at hand for spoons, syringes, or other 
instruments employed in the treatment; and spoons, 
cups and dishes used in feeding must be carefully 
sterilized by boiling for twenty minutes. 



316 HYGIENE OF THE NURSERY 

Fumigate the sick-room as soon as the patient 
leaves it. To do this, tightly close the room and 
stuff all apertures, such as keyholes, loose window 
sashes, spaces under doors and so on, with cotton 
or rags. Then, by means of a lamp provided for 
the purpose, or by a Lister fumigator, the air is 
saturated with formaldehyde gas and the room 
kept closed for at least twelve hours and then 
thoroughly aired. 

Wood-work and walls, if painted, should be 
wiped down with a solution of bichloride of mercury 
(i to 2000) and then scrubbed with soap and hot 
water, and the floor should be thoroughly scrubbed 
with the same solution. Repapering and fresh 
painting are necessary after cases of scarlet fever or 
small-pox. 

The person of the nurse may be disinfected in 
the way already indicated for the patient. 

Both milk and water will carry disease germs, 
and hence both must be sterilized when there is 
any danger of their being contaminated. Never 
give delicacies or articles of food that have stood 
in the sick room to other members of the household. 

VACCINATION. 

Every infant should be vaccinated. The proper 
time is between the third and sixth month, though 
the operation may be postponed if there be any 



EMERGENCIES 317 

disease of the skin, and in very delicate subjects, 
if there be no risk of exposure to small-pox. The 
point selected for the introduction of the virus 
should be on a part of the body that can be readily 
protected and kept at rest; the leg in infants, 
before the ages of creeping and walking, the arm 
in later life. If the first insertion be unsuccessful, 
it must be repeated after a month's interval, and 
continued efforts made until the end is attained. 
A second vaccination should be done before 
puberty, though an exposure, or any risk of expo- 
sure, always indicates immediate re-vaccination. 

VARIOUS DRESSINGS. 
POULTICES. 

Poultices may be made with corn-meal, bread, 
starch, ground slippery elm, flax-seed meal, or, in 
fact, any material that will retain heat and moisture. 
Flax-seed meal is usually selected because it is 
bland and non-irritating; because it contains con- 
siderable oil, which gives it great heat-retaining 
properties, and because it is cheap. 

All poultices should be large, from half an inch 
to an inch thick, applied as hot as can be borne, 
and renewed as soon as cold. A covering of oiled 
silk or thin rubber cloth is useful to prevent rapid 
cooling and drying. 



318 HYGIENE OF THE NURSERY 

FLAX-SEED POULTICE. 

Take a perfectly clean bowl, pour in the requisite 
quantity of boiling water, then add the flax-seed 
meal slowly, stirring continually with a large spoon 
to prevent the formation of lumps, until it becomes 
stiff enough not to run freely. Spread between 
two layers of clean muslin, folding the edges over so 
as to avoid soiling the part to which it is applied. 

THE JACKET POULTICE. 

The jacket poultice, sometimes employed in 
cases of pneumonia, requires some skill in its 
preparation. 

For a child from one to three years old, use about 
a pound of flax-seed meal in each poultice. 

Take a piece of muslin or a large towel long 
enough to go entirely around the patient's chest, and 
of sufficient width, when folded on itself, to extend 
from the collar-bone to a few inches below the 
lower end of the breast-bone. After the meal is 
properly mixed, spread it evenly over one entire half, 
lengthwise, of the cloth, which should then be 
folded over. Place this around the chest, with the 
open edge upward, and fasten behind. It should be 
held up by a tape passing over each shoulder. 

Put this poultice on as hot as the nurse can 
tolerate it against her cheek; cover with oiled silk 
and renew everv three or four hours. When the 



EMERGENCIES 3 10 

cool poultice is to be removed have a hot fresh one 
ready for immediate application. 

COTTON JACKET. 

This dressing has almost supplanted the jacket 
poultice in the treatment of pneumonia in children, 
because it is more readily applied, is much lighter 
and consequently interferes less with the respiratory 
movements of the chest wall, maintains a more 
uniform temperature, requires changing less fre- 
quently, thereby avoiding fatigue and exposure, 
and is capable of gradual removal by thinning the 
cotton from time to time. 

A muslin waist or a merino undershirt forms 
the frame of the cotton jacket. If a shirt be used 
it must have the sleeves cut off, be" opened all the 
way down in front, and so arranged that when put 
on it may be closed by tapes. A waist should reach 
well up in front and behind, and down to the base 
of the chest, and be fastened over the shoulders and 
in front by tapes. To the inside of either frame, 
a thick layer of cotton must be basted, and to the 
outside a complete covering of oiled silk. Such a 
jacket need not be changed oftener than once in 
twenty-four hours, and may be worn much longer 
if the cotton does not become too saturated with per- 
spiration or rolled into hard balls by the restless 
movements of the patient. 



320 HYGIENE OF THE NURSERY 

PLASTERS. 
MUSTARD PLASTER. 

These plasters are used for the purpose of making 
counterirritation, and must be graduated in strength 
according to the tenderness of the skin and the end 
to be accomplished. Pure mustard is very irri- 
tating and will quickly blister the tender skin of a 
child. Flour is the ordinary diluent, and the 
strength of the plaster usually ranges from one 
part of mustard to three, six, or even more parts of 
wheat flour. 

In making the plaster, take one teaspoonful of 
mustard flour and add to it three teaspoonfuls of 
wheat flour; mix them together thoroughly on a 
plate, and put on as much hot water (never vinegar) 
as may be necessary to make a soft mass. Spread 
evenly over a piece of muslin. To prevent the 
mustard from adhering to the skin, place a piece of 
gauze or thin muslin over the surface of the plaster; 
turn down the edges as in poultices. 

Remove the plaster after the surface becomes 
quite red, usually three to five minutes. 

DRY, HEATED APPLICATIONS. 

Make a bag of thick flannel, somewhat larger 
than the part to be covered. Half fill it with hot 
bran, hops, chamomile flowers, or whatever is to be 
used. Apply to the part on which it is intended to 



EMERGENCIES 32 1 

act. Retain it there by a bandage. When the bag 
and contents become cooled, quickly remove, sub- 
stituting a few thicknesses of hot flannel until the 
bag can again be heated by placing it on a tin plate 
in the oven, or by holding it over burning coals, 
being careful, of course, not to scorch it. 

COLD-WATER DRESSING. 

Take a piece of clean old linen or muslin large 
enough to cover the affected part. Thoroughly 
wet with cold water. Keep constantly wet by 
redipping in the cold water, or by gently squeezing 
out a wet sponge on the cloth, so as to keep it wet 
without dripping. The latter plan is the better, as 
it causes no disturbance of the parts beneath — an 
important consideration in many cases. 

HOT-WATER DRESSING. 

The hot-water dressing is prepared in the same 
way as the above, substituting hot water for cold 
water, and covering with oiled silk. 

TURPENTINE STUPE. 

A turpentine stupe is made by wringing a piece 
of soft flannel out of hot water and sprinkling a few 
drops of warm spirits of turpentine on it. It should 
be covered with oiled silk while applied, and re- 
moved when sufficient irritation of the surface is 
produced. 



322 HYGIENE OF THE NURSERY 

ADMINISTRATION OF MEDICINE. 

The administration of medicine often requires 
considerable skill, and is a task in which more 
clumsiness than tact is often exhibited. Teach the 
nurse that a child cannot swallow as long as the 
spoon is between the teeth, but that it is advisable 
to depress the tongue a brief moment and withdraw 
the spoon as soon as emptied. Should the child 
rebel, there are many ways by which he can be 
diverted, so that he shall swallow his medicine before 
he knows it. Also, should he have a fondness for 
any special thing, such as sugar, jelly, etc., the taste 
of the medicine may be quite hidden by mixing it 
with the thing he loves. 

Children should be early taught to show tongue 
and throat and to gargle; should be encouraged 
to look upon a Physician's visit as a pleasant event, 
and never be terrorized into compliance by threats 
of what the Doctor may say or do. 



INDEX. 



Abdomen, depression of, 7 

distention of, 7 
Adbominal belt, dispensing with, 

80 
Abnormal depression of tempera- 
ture, 41 
Accidents at birth, 279 

in chidhood, 286 
Adenoid growths, symptoms of, 19 
Air, importance of fresh, 63 
Airing, 100 

in-doors, 101 

out-doors, 1 01 
Albumin water, 202, 253 
Ammonia, 68 
Amusements, 98 
Anaemia, temperature in, 41 
Analysis of cow's milk, 171 

of human milk, 169 

of peptonized milk, 201 
Ankle, pressure about the, 91 
Aphthae, 43 
Appetite, 23 

loss of, 24 
Apple, scraped, 225 
Applications, dry heated, 320 
Apron, the bath, 126 
Arrowroot pudding, 248 
Artificial feeding, 166 
Asses' milk, 170 

Atmospheric air, the amount re- 
quired for each child, 54 
Attenuants, 183 
Author's sterilizer, 215 



Baby band, 80 

carriage, 102 

jumper, dangers of, 104 

powder, 130 
Baby's basket, the filling of, 77 
Bacteria in milk, 214, 219 
Baked flours, 188 



Bare legs and knees, condemned, 

75 
Barley jelly, 202, 256 
and milk, 205 

water, 202, 253 
Bath apron, 126 

best hour for, 126 

blanket, 140 

bran, 141 

chair, 126 

cold, 137 

cooled, 138 

daily full, 121 

disinfectant, 141 

"don'ts," 129 

drying after, 128 

for first ten days, 120 

hot, 139 

hot air, 133 

in hot weather, 130 

mode of giving, 122, 127 

mustard, 140 

quantity of water required 
for, 123 

salt water, 140 

sea, 134 

soap, 125 

soda, 141 

table, 122 

temperature of, 123, 137 

the initial, 119 

thermometer, 124 

vapor, 141 

when to omit, 131 

water for, 123 
Bathing, 123 

after third year, 131 

on lap, 120 

suit, 135 

time occupied in, 131 

utensils, 122 
Bed coverings, 115 

remaking, 1 16 

separate, 1 14 

wetting the, 29 
Beef broth, 244 

juice (raw), 202, 244 



323 



3 2 4 



INDEX 



Beef, raw, 245 

tea, peptonized, 241 

wine and iron, 158 
Bicarbonate of sodium in modi- 
fication of milk, 182 
Bichloride solutions, care of, 289 
Bicycles, dangers of, no 
Binder, the, 80 

method of fastening, 80 

when to discard, 94 
Birth, injuries received during, 

279 
Blanc mange, 243 
Bleeding from the navel string, 
280 

from the nose, 295 
Body clothing, 81 

temperature, 39 
Boots, rubber, 96 
Bottle habit, 206 

tip, 208 

use of for drinking water, 153 
Boy or girl, clothing of, 94 
Braces, 107 

Brain, "water on the," 6 
Bran bath, 141 
Bread, 227 
Breast feeding, 147 

importance of regularity in, 
. x 49 

time allowed for each meal, 
149 

milk, analysis of, 169 

conservation of, 152, 162 
specific gravity of, 169 
Breasts, swelling of, 283 
Breathing, accelerated, 32 

diminished frequency of, 32 
Brick-dust deposit, 30 
Broth, beef, 244 

chicken, 246 

mutton, 247 

veal, 247 
Broths, meats, etc., 244 
Brows, contraction of, 3 
Bruises, 286 
Burns and scalds, 290 
Buttocks and thighs, bathing of, 
130 



C. 

Cans for milk, 212 

Cap, 93 

Capacity of stomach, 179 

Carriage, proper kind of, 102 

Casein in cow's milk, 172 

in human milk, 172 

relative proportions in cows' 
and human milk, 173 



Castile soap, unscented, 125 
Cereal gruels, 231 

dextrinized, 237 
Cereals, 177, 226 
Chamber, training infants to use, 

30s 
Chapin's formulas, 237 
Chapin's top-milk mixtures, 236 
Chart for recording weight and 

length, 10 
Chest, girth of, 13 
Cheyne-Stokes' respiration, 33 
Chicken broth, 246 
Child, position of, while being fed, 

2 10 
Childhood, 2 

and youth, bathing in, 133 

diet in, 224 
Chill, a, 309 
Chorea, diet and regimen in, 265 

massage in, 275 
Cinchona, ferrated elixir of, 158 
Clear brown soup, 245 
Cleft palate, 284 
Cleanliness in milking, 212 
Clinical thermometer, 37 
Clothing, 7 5 

change of, 96 

shortening of, 84 

warmth of, 75 

weight of, 13 
Coagulation of cow's milk, 174 

of human milk, 174 
Coated tongue, 43 
Cold bath, 137 

cream, 130 

pack, 138 
Colds, 296 

Cold-water dressing, 321 
Colic, 273, 301 

massage in, 273 
Colostrum, 147 
Compresses, 142 
Condensed milk, 174, 19s 

advantages and defects 
of, 175 
Consomme\ 246 
Constipation, 272, 302 

massage in, 272 
Contagious diseases, 313 

table of, 311 
Contamination of milk, 214 
Contraction of brows, 3 
Convulsions, 3, 20, 308 
Cooled bath, 138 
Copperas, 68 
Corsets, 107 
Cotton jacket, 319 
Cough, 21 
Cows, care of, 211 
Cows' milk, analysis of, 171 



INDEX 



325 



Cows' milk, care of, 212 

modification of, 180 
Cream with condensed milk, 176 

in modification of milk, 181 

gravity, 184 
Creeping, 103 
Crib, 114 
Croup, 297 
Cry of hunger, colic, etc., 20, 151 

whispering, 2 1 
Crying, 20 

variations in disease, 20 
Cuts, 288 
Cracked-wheat water, 253 



Debility, massage in, 274 
Deformed head, 5 
Dentition, 44 

abnormal, 45 
delayed, 46 
irregular, 46 
premature, 46 
Desserts, 227 
Development, 7 

examples of variations in dis- 
ease, 17 
Diagram showing relative stature, 
14 
showing eruption of milk 

teeth, 44 
showing relation between per- 
manent and temporary 
teeth, 48 
Diaper, 79 

washing and drying, 79, 80 
when to discard, 94 
Diarrhoea, 27 

Diet and regimen in chorea, 265 
during the eighth and ninth 
months, 186 
the first week, 184 
the sixth and seventh 
months, 186 
for acute gastrointestinal 
disorders, 258 
chronic diarrhcea, six to 

twelve months, 260 
chronic gastrointesti- 
nal catarrh, 259 
chronic vomiting of in- 
fants 259 
feeble digestion, age four 

months, 257 
habitual constipation, 

infants, 261 
older children, 262 
mucous disease, 259 



Diet from the second to the sixth 
week, 185 
the sixth week to the end 

of two months, 185 
the third to the sixth 

month, 185 
the tenth to the four- 
teenth month, 188 
the fourteenth to the 
eighteenth month, 189 
eighteen months to two 

and a half years, 190 
two and a half to three 
and a half years, 191 
in acute nephritis, 263 
gouty eczema, 264 
illness, 229 
infantile scurvy, 262 
lithaemia, 264 
pulmonary phthisis, 265 
rickets, 264 
Dietary, 230 

in childhood, 224 
in special diseases, 237 
"no milk," for acute gastro- 
intestinal disorders, 258 
Diseases, contagious, 3 13 
Disinfectants, definition of, 313 
Disinfection, etc., 313 
Donkey, a, 106 
Drawers, separable, 85 
Dress, or slip, 81 

night, 92 
Dressing gown, 92 
Drink, 228 
Drinking, 22, 192 

water, 192 
Drowsiness, long-continued, 19 
Dry malt extracts, 184 
Drying after bath, 128 



Earache, 19, 296 
Ear, foreign bodies in, 292 
Early rising, 113 
Ear-tabs, 96 
Ears, water in, 128 
Eating between meals, 229 
Efiieurage, 268 
Egg and brandy, 252 
Eggs, 226 
Emergencies, 278 
Bnemata, nutritious, 256 
Erect carriage, securing of, 107 
Eructation of milk, 25 
Eruptive fevers, table of, 310 
Electricity with massage, 27s 
Electric light in nursery, 56 
Evacuations, faecal, 26 



326 



INDEX 



Evacuations, normal number of, 26 
Excoriations, 80 
Exercise, effects of, 98 

the infant's first, 99 

out-door, 101 
Expectoration, absence of in young 

children, 22 
Extract of malt, 158 
Eyeballs, oscillation of, 3 
Eyes, change of color of the, 17 

foreign bodies in the, 292 

inflammation of the, 283 

lividity of the lids, 5 

washing of, 120 
Eyelids, incomplete closure of, 2 

twitching of, 2 



Face, the, 2 

congested or blackened, 280 

examples of variations in dis- 
ease, 2 
Faecal evacuations, general charac- 
ter of, 26 
Fasces, retention of, 282 
Fall and winter, diseases of, 278 
False palate, 285 
Fat in cow's milk, 181 

in human milk, 169 
Farinaceous food, 177 
Feather bed, objections to, 115 
Features of health, 1 
Feeding, artificial, 166 

by a wet-nurse, 164 

from the maternal breast , 146 

mixed, 152, 162 

table of intervals of, 187 

too constant, 150 

time of difficult, 194 

with cup, 206 
Fender, 63 
Fever, 35, 43, 309 
Fevers, table of eruptive, 310 
Feet, cold, 91 

shape of, 89 
Finger nails, care of, 143 
Fireplace, open, 62 
Fish, 226 

Fissure of nipples, 158 
Flax-seed tea, 252 

poultice, 318 
Flies and mosquitoes, dangers 

from, 59 
Flour ball, 25s 
Fontanelle, conditions of, 5, 6, 7 

when it should close, 17 
Food, 146 

articles to select from in 
childhood, 22s 



Food, administration of artificial, 
206 

average amounts of, 178 

farinaceous, 177 

fried, 229 

indications for minor changes 
in, 203 

Meigs', 195 

milk and oatmeal, 230 

milk and white of egg, 238 

quantity per diem, 178 
Foods, peptonized, 197 
Foot-bath, mustard, 140 
Foreign bodies in the alimentary 
canal, 295 

laxative, contraindicated in, 

295 *u 

in the ear, 292 

in the eye, 292 

in the nose, 294 

in the throat, 294 

Fractures, 287 

Friction, 268, 271 

Fruits, 227 

Fumigation, 316 



Garments, method of fastening, 83 

Garter, 86 

Gastric juice, effect of, on milk, 

174 
Gelatine, 255 

and milk, 250 
Genitals, care of, 128 
Glutin suppositories, 307 
"Gluttony, 24 

Glycerin, suppositories, 308 
Goats' milk, 170 
Gown, dressing, 92 
Graduated nursing bottle, 207 
Gravity cream, 184 
Growth, 7, 12, 14 
Gruel, oatmeal, 251 

cereal, 237 

dextrinized, 237 



Habitual constipation, 302 

diet for, 261, 262 
Hair, care of, 144 

change of color in, 17 
drying of, 132 
falling out of, 144 
tonic, 145 
Hand, carrying of, to head or 
mouth, 19 



INDEX 



3 2 7 



Hard palate, 43 

Harelip and cleft palate, 284 

age for operating on, 284 
Hat, light straw, 93 
Head, shape of, 5 

after prolonged labor, 279 

squareness of, 6 

washing of , 121, 129, 132 

when it can be held erect, 16 
Health, the features of, 1 
Healthy skin, characters of, 3 
Hereditary tendency, 279 
Hoarseness, 21 
Hominy grits, 249 
Horlick's Food, 183 
Hot bath, 139 
Hot-water dressing, 321 
Human milk, analysis of, 169 

substitutes for, 170 
Humanized milk, 201, 242 
Hunger, 23 
Hydrocephalus, 6 



I. 



Ice water, 109, 192 
Indigestion, massage in, 271 
Indications for minor changes in 

food, 203 
Infancy, definition of, 1 
Infant, clothing required by, 78 
holding in place, 83 

development of the, 7 

drying of the, 127 

fed upon condensed milk, 174 

foods, 177 

initial bath of, 119 

overfed, 179 

position of, while feeding, 210 
while nursing, 148 

rocking of, 116 

the hardening of an, 101 

the jolting of an, 100 

when able to sit up, 99 
creep, etc., 103 
Inflammation of the eyes, 283 
Injuries received during birth, 279 
Insects, stings of, 291 
Intervals of feeding, table of, 180 



J- 

Jacket, cotton, 319 
poultice, 318 

Jaundice, 5. 30 

Jelly, sago, 251 

Junket, 249 

with egg, 249 



Lactation, 148 

diet during, 157 
normal duration of, 153 

Lactalbumin, relative proportions 
in cow's and human milk, 173 

Lactometer, 171 

Leggings, 93, 96 

Legs, bare, 76 

Length-chart, 10 

Liebig foods, 186 

Light, night, 56 

Lime, saccharated solution of, 183 
water, 182, 254 

Lime water in modification of 
milk, 182 

Lips, lividity of, 5 



M. 

Malt extract, 158 
Mammary abscess, 160 
Mammary glands, inflammation 

of, 283 
Manna, 307 
Manners, 107 
Massage, 267 

a frictions, 268 

dry, 269 
Maternal feeding, 146 
Mattress, 114 

Meals, arrangement of, in child- 
hood, 228 

preparation of, 209 

of day's supply, 209 
of separate bottles, 210 

regularity of, 149 
Meat, 226 

broths, 244 
Medicine, administration of, 322 

closet, contents of, 60, 61 
Meigs' Food, 19s 
Mellin's Food, 183, 205 

laxative action of, 188 
Menstruation, effect of recurrence ' 

on breast milk, 160 
Milk, 225 

bacteria in, 214, 219 

contamination of, 214 

and barley jelly, 205 

and gelatine, 250 

and oatmeal, 230 

and white of egg food, 238 

asses', 170 

boiled, 19s 

breast, 168 

examination of, 169 
regulation of the flow of, 
148 



328 



Milk, breast, scanty secretion of, 
IS8 
specific gravity of, 169 
substitutes for, 170 
to ascertain the quantity 
sucked, 161 
condensed, 174 



goats ,170 

gruel, peptonized, 240 

human, 169 

humanized, 201, 242 

keeping of, 212, 213 

mixed, 211 

modification of, 180 

partially peptonized, 199, 239 

pasteurization, 218 
danger of, 213 
when to employ, 224 

pasteurized, cooling and care 
of, 223 
keeping of, 224 

peptonized, 197 

analysis of, 201 

powder, peptogenic, 199 

predigested, 197 

secretion established, 147 

sound, 211 

sterilized, 214 

sugar, 181 

teeth, 44 

care of, 143 

transportation of, 212 
Mind, cultivation of, 107 
Modification of cows' milk, 180 
Morals, general, 108 
Mouth, examination of, 41 

inflammation of, 22 

mucous membrane of, 43 

washing of , 121, 128 
Mustard bath, 140 

plaster, 320 
Mutton broth, 247 

N. 

Nap, the morning, 112 

Napkins, 79 

Navel string, bleeding from, 280, 

281 
Neurasthenia, massage in, 276 
New-born infant, length, weight, 

etc., 7 
Night dress, 92, 95 

light, 56 
Nipple, fissures of, 158 

preparation of the, 159 

protector, 159 

"No milk" diet, 258 
Nose, 3 



Nose, bleeding from the, 295 

cleaning of, 128 

foreign bodies in the, 294 

rubbing of the, 20 
Nostrils, sharpness of, 3 
Nursery, 51 

airing of, 67 

cleaning the, 67 

floor of the, 57 

furnishing of the, 57 

heating of the, 61 

height of ceiling of the, 55 

lighting of the, 55 

night, 52 

situation of the, 52 

size of the, 54 

smoking forbidden in, 67 

sun-light in, 52 

temperature of the, 61 

ventilation of the, 63, 67 

walls and ceiling, 58, 59 
Nurse-maid, 69 

cleanliness of, 73 

duty of mother to, 73 

face of, 7 1 

selection of, age, etc., 70 
Nursing bottle, care of, 208 
graduated, 207 
tip, 209 

for cleft palate, 285 
Nutritious enemata, 256 



Oatmeal gruel, 251 

water, 253 
Opium preparations, dangers of, 61 
Oral mucous membrane, 42 

respiration, 33 
Orange juice, 192 

quantity to be given, 193 
Overcoat, 93 
Overfeeding, 179 
Oyster soup, 247 
Oysters, peptonized, 241 
Oxide of zinc ointment, 130 



Palate, false, 28s 

hard and soft, 43 
Pancreatin, 197 
Paralysis, facial, massage for, 276 

infantile, massage for, 274 
Pasteurization, 219 

advantages of, 224 

effect of, on microorganisms, 
219 

with improvised apparatus, 
223 



329 



Pasteurizer, Dr. Freeman's, 220 
Passages, character of, 27 
Pathogenic organisms in milk, 214 
Pearl barley jelly, 256 
Peptogenic milk powder, 199 
Peptonization, 197 

by cold process, 240 

partial, 199, 257 
Peptonized beef tea, 241 

foods, 238 

milk, 238, 239 
gruel, 240 

oysters, 241 
Petrissage, 268 
Phosphate of sodium, 307 
Physiological action of massage, 

269 
Pictures in nursery, 58 
Pillow, the, us 
Plasters, mustard, 320 
Piatt's chlorides, 68 
Play, 109 

during convalescence, no 
Pleuritic effusions, massage for, 

276 
Position and gestures, 18 
Position in bottle feeding, 210 
Pony, the, 106 
Poultices, 317 

jacket, 318 
Powder, baby, 130 
Predigested milk, 197 
Pregnancy, effect of on breast- 
milk, 160 
Prepared chalk, 142 
Preparation of food, 184 
Protector, nipple, 159 
Proteids in cows' milk, 172 

in human milk, 169 
Puberty, bathing after, 133 
Pudding, arrowroot, 248 

rice, 250 

tapioca, 252 
Pulse, the, 33 

in fever, 35 
Pyramid night light, 56 



Rain water, 1 23 
Raw beef, 24 s 

juice, 202, 244 
Reaction of cows' milk, 171 

of human milk, 169 
Rectal temperature, 38 
Regular nursing, influence in milk, 

149 
Regurgitation of milk, 25 
Rennet, 249 
Respiration, 31 



Retention of fasces and of urine, 

282 
Retiring at night, 1 14 
Rice milk, 250 

pudding, 250 

water, 253 
Rickets, 6, 19, 17s 
Riding, 106 
Rising early, 113 
Robinson's barley, 188 
Rocking baby to sleep, 116 
Roller skates, no 
Roof of the mouth, 43 
Rubber cloth, 84, 92 
Rubbing, 270 



S. 



Sago jelly, 251 

Saliva, secretion of, 17 

Salt-water bath, 140 

Scalds, 290 

Scalp, swelling of, 280 

Screens for nursery windows, 59 

Scurvy from condensed milk, 175 

from farinaceous foods, 177 
Sea-bathing, 13 s 

faintness after, 135 

season for, 134 
Sea-water baths, 134 
Secondary bleeding from the 

navel, 281 
Second dentition, features of, 49 
Set walks, 105 
Shirt, night, 92 
Shoes, 87 

fastenings, 91 

soles, 91 
Shoes, bedroom, 93 

knitted, worsted, 79 
Short stockings, dangers of, 75 
Sick room, disinfection of, 313 
Sitting erect, 16 
Skates, roller, dangers of, no 
Skin, general appearance of, 3 

of healthy child, 3 

yellow staining of, 282 
Sleep, in 

amount required, ill 

training for, 1 1 1 

variations in disease, 19 
Sleeping " cool," 19 

" high," 19 

hours, rules for, 1 1 2 

out-of-doors, 1 16 
Soap, Castile, 125 

care in use of, 1 2 5 

suppositories, 307 
Soda bath, 141 
Solution of lime, saccharated, 183 



33° 



INDEX 



Sore nipples, 158 

prevention of, 159 
Sound milk, 211 
Soup, clear brown, 245 

oyster, 247 
Soups, 227 

Spasmodic croup, 297 
Spine, curvature of, 99 
Spinal irritability, massage for, 

276 
Sponge, 125 

care of, 125 
Sponging, 120 

time occupied in, 132 

to reduce temperature, 139 
Sprains, 287 
Spring and summer, diseases of, 

279 
Squinting, 3 
Standing, 17 
Starch gruel, 237 
Stationary wash stands, cleaning 

of, 68 
Sterilization, 214 
Sterilized milk, properties of, 217 
Sterilizer, 215 

Stick for cleaning teeth, 143 
Stimulants for scanty milk secre- 
tion, 158 
Stings of insects, 291 
Stockings, 85 
Stomach, capacity of, 179 
Study, too much, 109 
St. Vitus's dance, massage in, 275 
Substitutes for human milk, 170 
Suck, manner of giving, 148 
Sugar in cows' milk, 171 

in human milk, 169 

in modification of milk, 181 

of milk, 181 

solution, 181 
Summer night-gown, 92 
Suppositories, glutin, 307 

glycerin, 308 

soap, 307 
Swallowing, 22 
Swelling of the breasts, 283 
Swimming, 136 
Syphilis in nurse-maid, 70 
Syringe for constipation, 303 

nutritive enemata, 256 



Table of average amounts of food, 
180 
of feeding, 187 
Table, the bath, 122 
Table of the eruptive fevers, 310 
of other contagious diseases, 
311 



Table showing increase in length, 
8 
in weight, 9 
Taking cold easily, 106 
Talking, 17 
Tapioca, 251 

pudding, 252 
Tapotement, 209 
Tears, secretion of, 17 

suppression of, 21 
Teeth, care of, 142 

permanent, order of eruption, 

premature appearance of, 45 

children bom with, 45 

milk, 43 

stick for cleaning, 143 
Teething, increase of saliva in, 45 

pauses in, 44 
Temperature of bath, 123, 137 

nurseries, 62 

manner of taking, 37 

normal, 39 

range of in health, 40 
in disease, 40 
Thermometer, bath, 124 

clinical, 37 

food, 210, 242 
Throat, examination of, 41 

foreign bodies in the, 294 
Toes, normal position of, 89 
Toe nails, care of, 94, 143 
Tongue, the, 42 

coated, 43 
Tongue-tie, 286 
Tonsils, 19, 43 
Tooth-brush, 143 
"Top milk," 231 

mixtures, 232 

change to whole milk, 233 
Towels, bath, 125 
Toys, 60 
Treatment of fissure of the nipple, 

158 
Tuberculin test for cows, 211 
Turpentine stupe, 321 
Twitching of eyelids, 3 



Ulceration of the navel, 281 
Underclothing, cotton stockinet, 95 

linen-mesh, 95 

woolen, 94 
Urination, painful, 30 
Urine, the, 28 

amount voided in 24 hours, 29 

high colored, 30 

incontinence of, 29 

in jaundice, 30 



INDEX 



331 



Urine, retention of, 282 

smoky, 30 

suppression of, 29 
Uvula, the, 43 
Uric acid, excess of, 30 

V. 

Vaccination, 316 
Veal broth, 202, 247 
Vegetables, 226 
Ventilation, 54, 63 
Ventilator board, 66 

wheel, 66 

window, 64 
Vemix caseosa, 119 
Veterinary inspection of cows, 211 
Voice, 20 

variations in disease, 20 
Vomiting, 25, 300 

W. 

Walking, delay in, 18 
Walks, 104 
Wash cloth, 125 

care of, 125 
Waste pipe, disinfection of, 68 
Water, for drinking, 192 

in the ears, 128 

on the brain, 6 
Weaning, 153 

gradual, 154 

indications for, on part of 
infant, 162 
mother, 156 



96 



Weaning in difficult cases, 155 

in summer, 153 

manner of, 154 

premature, 156 

sudden, 155 
Weather, cold, 96 

damp and rainy, 
Weight-chart, 10, n 

recording of, 1 2 

table showing increase of, 9 

monthly gain of, 9 
Wet-nurse, 164 

selection of, 164 
Wetting the bed, 29 
Whey, 195, 254 

mixtures, 196 

wine, 252 
Window screen, 59 

ventilator, 64 
Winter night-gown, 92 

to summer clothing, rules for 
changing, 96 
Winters' formulas, 233 

general formulas, 234 

summer formulas, 235 



Yawning, 33 

Yellow staining of the skin, 



Zinc ointment, 130 



FEB 17 1913 



PUBLISHED 19 12 

PSYCHOLOGICAL MEDICINE. A Manual of Mental Diseases. 
2nd Edition. By Maurice Craig, m. a., m. d., f. r. c. p., 
Physician and Lecturer on Psychological Medicine, Guy's 
Hospital, London. Second Edition, Revised. 27 Plates, 
containing 90 Figures, 46 in colors. 8vo. Cloth, $5.00. 

A short account of the principles and practice of 
Psychological Medicine designed to meet the requirements 
of both practitioner and student. The opening chapter is 
devoted to a short description of normal psychology ; this 
is followed by one on the subject of law in its relationship 
to insanity, and matters such as testamentary capacity and 
criminal responsibility. As sleeplessness is a frequent 
cause and important symptom in most mental disorders a 
chapter has been reserved for its consideration. Through- 
out the book, the subject matter has been broken up into 
sections for the benefit of those who wish to refer to spec- 
ial matters only. The book is designedly simple in both 
arrangement and language, and is a summary of many 
vears asylum experience. 



PHARMACEUTICAL BACTERIOLOGY. By ALBERT SCHNEIDER, 

IS. d., ph. d., Professor of Pharmacognosy, Economic 
Pharmaceutical Botany, Histology and Bacteriology, in 
the California College of Pharmacy, San Francisco; 
Pharmacologist, U. S. Dept. of Agriculture. 86 Illustra- 
tions, most of which are from Original Drawings. 
Octavo. 246 Pages. Cloth, $2.00. 

The present volume is a product of the recent growth 
and development in the professional side of pharmacy. 
Attempts have been made to adhere strictly to the subject 
from the standpoint of the pharmacist, with only enough 
treatment of general bacteriology to make clear the col- 
lateral relationships, especially as it pertains to medical 
and commercial, or industrial bacteriology. 



COMPEND OF GENITO-URINARY AND VENEREAL DISEASES, 
AND SYPHILIS. 2nd Edition. By Charles S. Hirsch, 
m. d., Formerly Assistant Oenito-Urinary Surgery De- 
partment, Jefferson Medical College Hospital, Philadel- 
phia; Consulting Physician to Juvenile Protective Asso- 
ciation, Physician in Chief, Social Service House, Phila- 
delphia. Colored Frontispiece and 74 other Illustrations. 
Second Edition. 12mo. 378 Pages. Blakiston's ? Quiz- 
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P. BLA K I ST< >N-'S SON & CO., 

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FEB 17 



PUBLISHED 1912 

FATTY FOODS. Their Practical Examination. By E. RICHARDS 
Bolton, f. c. s., Consulting Analyst and Technical 
Chemist; and Cecil Revis, Chief Chemist. Messrs. Wel- 
ford & Sons, Limited, London. With 7 Plates and 36 
Text-figures. Small Octavo. Cloth, $3.50. 

This is a handbook for analytical and technical chemists 
who are continually faced with the problem of investigat- 
ing or recognizing the numerous fatty products which have 
made their appearance during recent years. The subject 
is treated in a systematic and practical manner, and the 
methods described are those which give reliable results. 



HARE-LIP AND CLEFT-PALATE. By JAMES BERBV, B. S. 

(Lond.), f. r. c. s., Surgeon to the Royal Free Hospital, 
and Lecturer on Surgery; and T. Percy Legg, m. s., 
(Lond.), f. r. c. s., Surgeon to Royal Free Hospital at 
the London School of Medicine for Women. 242 Illus- 
trations. With an appendix of cases of operation for 
Cleft Palate. Octavo. Cloth, $4.00. 

This book describes in full detail the methods that have 
been found most useful by the authors. A special feature 
of the work is the illustrating, which has been done by a 
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tion and checked and corrected immediately afterwards by 
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describes the actual results of all the operations for cleft- 
palate. 

CLINICAL BACTERIOLOGY AND HAEMATOLOGY FOR PRAC- 
TITIONERS. 4th Edition. By W. D'Este Emery, m. d., 
b. sc. (Lond.), Clinical Pathologist to King's College 
Hospital. Fourth Edition. With 10 Plates containing 
62 Figures, some in Colors, and 52 other Illustrations. 
Octavo. 283 Pages. Cloth, $2.00. 

This book has been prepared for the practitioner who 
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formation as to how to proceed, and advice as to the cir- 
cumstances in which it is necessary to have recourse to 
expert assistance. Besides a thorough revision of the 
book there has been added a simplified method for the 
Wassermann reaction which serves as an introduction to a 
matter of profound importance to every medical man — the 
interpretation of the results of the test. This has been 
dealt with at some length. 



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PUBLISH ERS. PHILADEL PHIA. 



TWELFTH EDITION 

Potter's "Therapeutics, 
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Including the physiological Action of Drugs, 
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Revised en Accordance with the Latest Reprint 
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each main division indicated by a thumb index. 



By Samuel 0. L. Potter, M. A., M. D., M. R. C. P., (LondJ 

Formerly Professor of the Principles and Practice of 

Medicine, Cooper Medical College, San Francisco; 

Major and Brigade Surgeon, V. S. Vol. 

TWELFTH EDITION. 42nd THOUSAND. 
Octavo, 972 Pages. Cloth, $5.00 Postpaid. 

In this, the twelfth edition, according to the au- 
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This statement is made with the object in view of 
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P. BLAKISTON'S So N & CO., 
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PUBLISHED 1912 



MALFORMATIONS. A Clinical Manual of the Malformations and 
Congenital Diseases of the Foetus. By Professor R. Birn- 
baum, Physician in Chief to the Clinic for Women in the 
Royal University of Gottingen. Translated and anno- 
tated by George Blacker, m. d., b. s. (Lond.) f. r. 
c. p., f. r. c. s., Eng. Obstetric Physician to the Uni- 
versity College Hospital and the Great Northern Central 
Hospital. With 8 Plates and 58 other Illustrations. 
Octavo. Cloth, $5.00. 

Malformations and Congenital Diseases are of interest 
from several points of view ; thus, they have an anatomi- 
cal, pathological, physiological, clinical — more especially 
in relation to Surgery and Obstetrics — and Medico legal im- 
portance. These facts have all been kept in mind in the pre- 
paration of this book. The translation of the book has been 
undertaken because there is no work of similar scope in the 
English language, and it was thought that this book will 
supply a want and prove useful to the practitioner. Con- 
siderable number of notes has been added to the original 
work. The illustrations are for the most part original 
photographs taken from specimens in the collection of the 
Gottingen Women's Clinic. 

DIAGNOSTIC METHODS. Chemical, Bacteriological and Micro- 
scopical. 2nd Edition. By Ralph W. Webster, m. d., 
ph. d., Assistant Professor of Pharmacological Therapeu- 
tics and Instructor in Medicine, Rush Medical College, 
University of CJiicago. Second Edition Revised and En- 
larged. Octavo. 717 Pages. 37 Colored Plates. 164 
other Illustrations. Cloth, $4.50. 

The type is clear, the text concise and practical. The 
book will be highly appreciated by those who desire a 
guide to the most recent methods of diagnosis and can be 
commended especially on account of the accuracy and clear- 
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METHODS OF I MMUNO-DIAGNOSIS AND IMMUNO-THERAPY. 
And Their Practical Application. By Dr. JULIUS CITRON, of 
Berlin. Translated from the German and edited by A. L. 
Garbat, m. d., Assistant Pathologist, German Hospital, 
Neio York. With 27 Illustrations. 2 Colored Plates. 8 
Charts. Octavo. Cloth, $3.00. 

"This is a helpful book to the practitioner who desires to 
acquaint himself with the latest thought regarding serum 
diagnosis and the most practical means for its use in his 
daily work." — Medical Times, New York. 



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THE PRACTICE OF 

OBSTETRICS 

New, 4th Edition 
TWENTY-FIFTH THOUSAND 

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with 131g illustrations. 46 colored figures. 
Octavo. 1084 Pages. Cloth, $6.00 Postpaid. 



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PRACTICAL 

GYNECOLOGY 

4th EDITION 

Revised, Rearranged, and in Parts Rewritten. 

By EDWARD E. MONTGOMERY, M. D. 

Professor of Gynecology in Jefferson Medical College, 

Philadelphia; Gynecologist to the Jefferson and 

St. Joseph's Hospitals, etc. 



589 illustrations (3 in colors). 
Octavo 879 Pages. Cloth, $6.00 Postpaid. 



"The latest edition of this well-known and popular 
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